Healthcare Provider Details

I. General information

NPI: 1861432999
Provider Name (Legal Business Name): REBECCA MICHELLE SNYDER LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: REBECCA MICHELLE GLATT LICSW

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 MILL ST
BELMONT MA
02478-1041
US

IV. Provider business mailing address

115 MILL ST
BELMONT MA
02478-1041
US

V. Phone/Fax

Practice location:
  • Phone: 617-855-2210
  • Fax: 617-855-3709
Mailing address:
  • Phone: 617-855-2210
  • Fax: 617-855-3709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number111081
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: