Healthcare Provider Details

I. General information

NPI: 1881799054
Provider Name (Legal Business Name): AUDREY BETH SNYDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FAMILY GROWTH PROGRAM 39 N. CLINTON AVE
TRENTON NJ
08609
US

IV. Provider business mailing address

176 MILLSTONE RD
MILLSTONE TOWNSHIP NJ
07726-8509
US

V. Phone/Fax

Practice location:
  • Phone: 609-394-5157
  • Fax: 609-394-3010
Mailing address:
  • Phone: 732-446-2461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC01428500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: