Provider Demographics
NPI:1902446628
Name:MCSWEENEY, COREY MATTHEW
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:MATTHEW
Last Name:MCSWEENEY
Suffix:
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 1:97 FREEHOLD HTS
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NY
Mailing Address - Zip Code:12431-5533
Mailing Address - Country:US
Mailing Address - Phone:518-929-1236
Mailing Address - Fax:
Practice Address - Street 1:905 GREENE COUNTY OFFICE BLDG
Practice Address - Street 2:
Practice Address - City:CAIRO
Practice Address - State:NY
Practice Address - Zip Code:12413-2868
Practice Address - Country:US
Practice Address - Phone:518-622-9163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104130104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty