Healthcare Provider Details

I. General information

NPI: 1780237982
Provider Name (Legal Business Name): CARLY ELIZABETH SNYDER MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2019
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 W CERVANTES ST
PENSACOLA FL
32501-3128
US

IV. Provider business mailing address

112 W CERVANTES ST
PENSACOLA FL
32501-3128
US

V. Phone/Fax

Practice location:
  • Phone: 850-261-3822
  • Fax:
Mailing address:
  • Phone: 850-261-3822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW19236
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW13755
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: