Healthcare Provider Details

I. General information

NPI: 1649301425
Provider Name (Legal Business Name): DEBRA BETH SNYDERMAN LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 CAMINO SIERRA VIS 129
SANTA FE NM
87505-1007
US

IV. Provider business mailing address

3810 KSK LN
SANTA FE NM
87507-3355
US

V. Phone/Fax

Practice location:
  • Phone: 505-467-2504
  • Fax: 505-467-2646
Mailing address:
  • Phone: 505-438-0595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: