Basic Information
| Provider Information | |||||||||
| NPI: | 1952796237 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SWEENEY | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.A. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 515 S CEDAR AVE | ||||||||
| Address2: | BLDG 320 | ||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937022908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596006041 | ||||||||
| FaxNumber: | 5596006090 | ||||||||
| Practice Location | |||||||||
| Address1: | 515 S CEDAR AVE | ||||||||
| Address2: | BLDG 320 | ||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937022908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596006046 | ||||||||
| FaxNumber: | 5596006090 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2015 | ||||||||
| LastUpdateDate: | 09/04/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.