Provider Demographics
NPI:1326231796
Name:SWEENEY, JEANNE (LCPC)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:
Last Name:SWEENEY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:JEANNE
Other - Middle Name:
Other - Last Name:GEARY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1412 TARRAGON CT
Mailing Address - Street 2:
Mailing Address - City:BELCAMP
Mailing Address - State:MD
Mailing Address - Zip Code:21017-1365
Mailing Address - Country:US
Mailing Address - Phone:410-599-9091
Mailing Address - Fax:410-828-6262
Practice Address - Street 1:28 ALLEGHENY AVE
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-3909
Practice Address - Country:US
Practice Address - Phone:410-828-0101
Practice Address - Fax:410-828-6262
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2267101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD014716800Medicaid