Healthcare Provider Details

I. General information

NPI: 1003945825
Provider Name (Legal Business Name): MISHA SNYDER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 05/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 LIVINGSTON ST
BROOKLYN NY
11201-5861
US

IV. Provider business mailing address

180 LIVINGSTON ST STE 303
BROOKLYN NY
11201-5861
US

V. Phone/Fax

Practice location:
  • Phone: 347-328-8110
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: