Provider Demographics
NPI:1699890392
Name:SWEENEY, TARA BRIANNE (LCSW)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:BRIANNE
Last Name:SWEENEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BRIANNE
Other - Middle Name:
Other - Last Name:SWEENEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:12580 CARMEL CREEK RD UNIT 48
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2379
Mailing Address - Country:US
Mailing Address - Phone:858-414-8217
Mailing Address - Fax:
Practice Address - Street 1:12580 CARMEL CREEK RD UNIT 48
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2379
Practice Address - Country:US
Practice Address - Phone:858-414-8217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA213791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical