Healthcare Provider Details

I. General information

NPI: 1871665349
Provider Name (Legal Business Name): LYNN ADELE SNYDER MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 02/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8270 BURNT STORE RD UNIT 3
PUNTA GORDA FL
33950-4705
US

IV. Provider business mailing address

8270 BURNT STORE RD UNIT 3
PUNTA GORDA FL
33950-4705
US

V. Phone/Fax

Practice location:
  • Phone: 941-505-8080
  • Fax: 941-505-8090
Mailing address:
  • Phone: 941-505-8080
  • Fax: 941-505-8090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW 11656
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number6018
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: