Healthcare Provider Details

I. General information

NPI: 1427061431
Provider Name (Legal Business Name): SUSAN MARIE SWEENEY M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 07/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 BENMONT AVE SUITE 20
BENNINGTON VT
05201-1873
US

IV. Provider business mailing address

160 BENMONT AVE SUITE 20
BENNINGTON VT
05201-1873
US

V. Phone/Fax

Practice location:
  • Phone: 802-442-3520
  • Fax: 802-447-3392
Mailing address:
  • Phone: 802-442-3520
  • Fax: 802-447-3392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0470000656
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: