Provider Demographics
NPI:1619860780
Name:SWEETSER, MARY KATHRYN (LSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KATHRYN
Last Name:SWEETSER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4638 NEWTON DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80916-3330
Mailing Address - Country:US
Mailing Address - Phone:479-422-7670
Mailing Address - Fax:
Practice Address - Street 1:7075 CAMPUS DR STE 202
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-6524
Practice Address - Country:US
Practice Address - Phone:719-888-6827
Practice Address - Fax:719-623-1149
Is Sole Proprietor?:No
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLSW.0009924986104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker