Healthcare Provider Details

I. General information

NPI: 1063043859
Provider Name (Legal Business Name): ANGELICA SNYDER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2020
Last Update Date: 02/19/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 N MAIN AVE
LOVINGTON NM
88260-2813
US

IV. Provider business mailing address

1600 N MAIN AVE
LOVINGTON NM
88260-2813
US

V. Phone/Fax

Practice location:
  • Phone: 575-396-6611
  • Fax:
Mailing address:
  • Phone: 575-396-6611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2022-0190
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: