Healthcare Provider Details

I. General information

NPI: 1922877497
Provider Name (Legal Business Name): KATHLEEN SWEENEY LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2023
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10805 HICKORY RIDGE RD STE 103
COLUMBIA MD
21044-3868
US

IV. Provider business mailing address

10805 HICKORY RIDGE RD STE 103
COLUMBIA MD
21044-3868
US

V. Phone/Fax

Practice location:
  • Phone: 646-696-9865
  • Fax:
Mailing address:
  • Phone: 646-696-9865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34913
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number130696
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SL07068300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: