Provider Demographics
NPI:1902146095
Name:SWEAZY, KERRY MARUCS III
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:MARUCS
Last Name:SWEAZY
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 W SIENA LN
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-2615
Mailing Address - Country:US
Mailing Address - Phone:559-681-5515
Mailing Address - Fax:
Practice Address - Street 1:3435 W SHAW AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3234
Practice Address - Country:US
Practice Address - Phone:559-275-1784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-26
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)