Healthcare Provider Details

I. General information

NPI: 1750518429
Provider Name (Legal Business Name): MELISSA A. SNYDER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELISSA CYR LMSW

II. Dates (important events)

Enumeration Date: 06/19/2009
Last Update Date: 12/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 POND RD
LEWISTON ME
04240-3326
US

IV. Provider business mailing address

PO BOX 2453
LEWISTON ME
04241-2453
US

V. Phone/Fax

Practice location:
  • Phone: 877-868-5741
  • Fax:
Mailing address:
  • Phone: 877-838-5741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberMC11383
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberMC11383
License Number StateME
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC12465
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: