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General NPI Number Information
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NPI Number | 1760510556
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Entity Type | Individual
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Provider Name | LISA INEZ SWEATT PH.D.
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Gender | Female
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1 GRAND AVE CAL POLY STATE UNIV.,PSYCHOLOGY & CHILD DEV. DEPARTMENT
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93407-9000
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Country | US
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Telephone | 805-756-6123
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Fax | 805-756-1134
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Provider Business Mailing Address
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Address Line | 1718 9TH ST
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City | LOS OSOS
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State | CA
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Zip | 93402-2225
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Country | US
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Telephone | 805-756-6123
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Fax | 805-756-1134
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 19226
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License Number State | CA
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