Healthcare Provider Details

I. General information

NPI: 1730441874
Provider Name (Legal Business Name): MS. KIMBERLY SNOW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2012
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

667 STONELEIGH AVE STE 202
CARMEL NY
10512-2455
US

IV. Provider business mailing address

5 AUTUMN RIDGE WAY
NEWBURGH NY
12550-8008
US

V. Phone/Fax

Practice location:
  • Phone: 845-279-5908
  • Fax:
Mailing address:
  • Phone: 845-913-6176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number097047-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: