Healthcare Provider Details

I. General information

NPI: 1750160313
Provider Name (Legal Business Name): JENNIFER SNEDEKER LMSW-CC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 09/25/2023
Certification Date: 09/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 BATH RD
BRUNSWICK ME
04011-2673
US

IV. Provider business mailing address

329 BATH RD
BRUNSWICK ME
04011-2673
US

V. Phone/Fax

Practice location:
  • Phone: 800-434-3000
  • Fax:
Mailing address:
  • Phone: 800-434-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberMC22676
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: