Healthcare Provider Details

I. General information

NPI: 1538122445
Provider Name (Legal Business Name): SWEETSER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 03/10/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 MOODY STREET
SACO ME
04072
US

IV. Provider business mailing address

50 MOODY STREET
SACO ME
04072
US

V. Phone/Fax

Practice location:
  • Phone: 800-434-3000
  • Fax: 207-294-4649
Mailing address:
  • Phone: 800-434-3000
  • Fax: 207-294-4649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number229941
License Number StateME

VIII. Authorized Official

Name: JAYNE VAN BRAMER
Title or Position: CEO
Credential:
Phone: 207-294-4651