Healthcare Provider Details

I. General information

NPI: 1245370063
Provider Name (Legal Business Name): DANA SNYDER-GRANT LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 OLD ROAD TO 9 ACRE COR
CONCORD MA
01742-4141
US

IV. Provider business mailing address

18 HALF MOON HL
ACTON MA
01720-2449
US

V. Phone/Fax

Practice location:
  • Phone: 978-369-1113
  • Fax: 978-369-0908
Mailing address:
  • Phone: 978-266-9409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1619380
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: