Healthcare Provider Details

I. General information

NPI: 1730480690
Provider Name (Legal Business Name): LEWIS WILKINS SNYDER M.ED.; LCPC-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2010
Last Update Date: 11/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 MOUNT HOPE AVE SUITE 320
BANGOR ME
04401-5691
US

IV. Provider business mailing address

700 MOUNT HOPE AVE SUITE 320
BANGOR ME
04401-5691
US

V. Phone/Fax

Practice location:
  • Phone: 207-941-2952
  • Fax: 207-941-2955
Mailing address:
  • Phone: 207-941-2952
  • Fax: 207-941-2955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberXL3716
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: