Provider Demographics
NPI:1730120320
Name:SWEENEY, JANE M (PHD)
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:M
Last Name:SWEENEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 CALLE MAGDALENA
Mailing Address - Street 2:STE. #204
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-3709
Mailing Address - Country:US
Mailing Address - Phone:760-924-2927
Mailing Address - Fax:
Practice Address - Street 1:187 CALLE MAGDALENA
Practice Address - Street 2:STE. #204
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3709
Practice Address - Country:US
Practice Address - Phone:760-924-2927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11566103TC0700X
CACP11566103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CP11566AMedicare PIN