Healthcare Provider Details

I. General information

NPI: 1093962730
Provider Name (Legal Business Name): KRISTIN I SWEENEY M. ED., LADC 1
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2008
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 COURT ST STE C
PLYMOUTH MA
02360-8713
US

IV. Provider business mailing address

174 ALDANA RD
HALIFAX MA
02338-1047
US

V. Phone/Fax

Practice location:
  • Phone: 781-908-0742
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number18960
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: