Healthcare Provider Details

I. General information

NPI: 1457865339
Provider Name (Legal Business Name): BARBARA SUSAN SNYDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2017
Last Update Date: 12/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2928 W 5TH ST APT 2P
BROOKLYN NY
11224-3935
US

IV. Provider business mailing address

2928 W 5TH ST APT 2P
BROOKLYN NY
11224-3935
US

V. Phone/Fax

Practice location:
  • Phone: 718-996-2663
  • Fax:
Mailing address:
  • Phone: 718-996-2663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number080791
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: