Healthcare Provider Details

I. General information

NPI: 1831704790
Provider Name (Legal Business Name): KIMBERLY SNAPPER MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2020
Last Update Date: 09/08/2020
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 BEDFORD ST STE 25
LEXINGTON MA
02420-4641
US

IV. Provider business mailing address

PO BOX 81087
WELLESLEY HILLS MA
02481-0001
US

V. Phone/Fax

Practice location:
  • Phone: 201-906-1199
  • Fax:
Mailing address:
  • Phone: 201-906-1199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number122482
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: