Provider Demographics
NPI:1033912910
Name:SWEET, SHALENE ANN
Entity type:Individual
Prefix:MS
First Name:SHALENE
Middle Name:ANN
Last Name:SWEET
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8616 LA TIJERA BLVD STE 408
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-3950
Mailing Address - Country:US
Mailing Address - Phone:310-337-7827
Mailing Address - Fax:
Practice Address - Street 1:10711 S 10TH AVE
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90303-2015
Practice Address - Country:US
Practice Address - Phone:310-948-9577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-28
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABACB865841106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician