Healthcare Provider Details

I. General information

NPI: 1023164498
Provider Name (Legal Business Name): ANNE G SNYDER LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANNE G TATE LISW

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 03/08/2023
Certification Date: 03/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 WYOMING BLVD NE STE 208
ALBUQUERQUE NM
87112-1033
US

IV. Provider business mailing address

2601 WYOMING BLVD NE SUITE 208
ALBUQUERQUE NM
87112
US

V. Phone/Fax

Practice location:
  • Phone: 505-503-0272
  • Fax:
Mailing address:
  • Phone: 505-503-0272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-06193
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: