Healthcare Provider Details

I. General information

NPI: 1174109573
Provider Name (Legal Business Name): JEFFREY SNYDER LCSW-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3298 KESSLER RD
HALETHORPE MD
21227-4743
US

IV. Provider business mailing address

4 IVORY CREST CT
BALTIMORE MD
21209-1561
US

V. Phone/Fax

Practice location:
  • Phone: 443-809-2478
  • Fax:
Mailing address:
  • Phone: 410-979-9948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number25992
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: