Provider Demographics
NPI:1417758467
Name:SWEENEY, JORDAN
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:SWEENEY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E MONTGOMERY AVE BSMT J0
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19003-2417
Mailing Address - Country:US
Mailing Address - Phone:717-406-7074
Mailing Address - Fax:
Practice Address - Street 1:954 MONTGOMERY AVE STE 2
Practice Address - Street 2:
Practice Address - City:PENN VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19072-1938
Practice Address - Country:US
Practice Address - Phone:412-212-8443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health