=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386807683
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAMELA CHRISTINA SWEENEY M.A., L.M.F.T.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2008
-----------------------------------------------------
Last Update Date | 07/07/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1330 LINCOLN AVE SUITE 209
-----------------------------------------------------
City | SAN RAFAEL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94901-2120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-455-5468
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1330 LINCOLN AVE SUITE 209
-----------------------------------------------------
City | SAN RAFAEL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94901-2120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-455-5468
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MFC34900
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------