Healthcare Provider Details

I. General information

NPI: 1669152989
Provider Name (Legal Business Name): MATTHEW SNEAD MHC-LP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2023
Last Update Date: 07/21/2023
Certification Date: 07/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

579 COURTLANDT AVE
BRONX NY
10451-5013
US

IV. Provider business mailing address

1302 ROSEDALE AVE APT 5C
BRONX NY
10472-1858
US

V. Phone/Fax

Practice location:
  • Phone: 718-485-2100
  • Fax:
Mailing address:
  • Phone: 937-360-8959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number18-P110253-02
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: