Healthcare Provider Details

I. General information

NPI: 1093251464
Provider Name (Legal Business Name): SORENA LYNN SWEATT LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SORENA LYNN EADDY LCSW-C

II. Dates (important events)

Enumeration Date: 01/10/2017
Last Update Date: 10/25/2020
Certification Date: 10/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6811 KENILWORTH AVE STE 500
RIVERDALE MD
20737-1318
US

IV. Provider business mailing address

7645 E ARBORY CT
LAUREL MD
20707-5537
US

V. Phone/Fax

Practice location:
  • Phone: 302-715-2503
  • Fax:
Mailing address:
  • Phone: 302-312-0363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number21212
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberLG50081996
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number21212
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: