Healthcare Provider Details

I. General information

NPI: 1528146891
Provider Name (Legal Business Name): MARY-JANE SNAIR LP C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 12/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 ROUTE 9 S SUITE 1000
FREEHOLD NJ
07728-1383
US

IV. Provider business mailing address

4400 ROUTE 9 S SUITE 1000
FREEHOLD NJ
07728-1383
US

V. Phone/Fax

Practice location:
  • Phone: 800-300-4079
  • Fax:
Mailing address:
  • Phone: 800-300-4079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00320200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: