Healthcare Provider Details

I. General information

NPI: 1093936270
Provider Name (Legal Business Name): SUSAN JO SNYDER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 11/20/2020
Certification Date: 11/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLUEGRASS HEALTH PSYCHOLOGY, INC. 2220 YOUNG DRIVE
LEXINGTON KY
40505-4219
US

IV. Provider business mailing address

BLUEGRASS HEALTH PSYCHOLOGY, INC. 4101 TATES CREEK CTR DR, STE 150 PMB 123
LEXINGTON KY
40517-3066
US

V. Phone/Fax

Practice location:
  • Phone: 859-277-1008
  • Fax: 859-277-1083
Mailing address:
  • Phone: 859-277-1008
  • Fax: 859-277-1083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number352
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: