Provider Demographics
NPI:1861208647
Name:SWEENEY, MICAH PATRICK (LCSW)
Entity type:Individual
Prefix:
First Name:MICAH
Middle Name:PATRICK
Last Name:SWEENEY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 MAE LN
Mailing Address - Street 2:
Mailing Address - City:MATAMORAS
Mailing Address - State:PA
Mailing Address - Zip Code:18336-2050
Mailing Address - Country:US
Mailing Address - Phone:845-649-2846
Mailing Address - Fax:
Practice Address - Street 1:4 MAE LN
Practice Address - Street 2:
Practice Address - City:MATAMORAS
Practice Address - State:PA
Practice Address - Zip Code:18336-2050
Practice Address - Country:US
Practice Address - Phone:845-649-2846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW1387351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical