Healthcare Provider Details

I. General information

NPI: 1780473033
Provider Name (Legal Business Name): ALISSA RENEE SWEENEY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2025
Last Update Date: 10/28/2026
Certification Date: 10/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4815 136TH AVE
HAMILTON MI
49419-9604
US

IV. Provider business mailing address

4815 136TH AVE
HAMILTON MI
49419-9604
US

V. Phone/Fax

Practice location:
  • Phone: 269-751-5148
  • Fax:
Mailing address:
  • Phone: 269-751-5148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801122914
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number6801122914
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: