Healthcare Provider Details

I. General information

NPI: 1881955524
Provider Name (Legal Business Name): TANYA RENEE SNAGGS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. TANYA RENEE EWAN-DESROSES

II. Dates (important events)

Enumeration Date: 05/30/2012
Last Update Date: 05/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 EAST 125TH STREET NYP - SBHC @ PROMISE ACADEMY
NEW YORK NY
10035
US

IV. Provider business mailing address

35 EAST 125TH STREET NYP - SBHC @ PROMISE ACADEMY
NEW YORK NY
10035
US

V. Phone/Fax

Practice location:
  • Phone: 646-537-4231
  • Fax:
Mailing address:
  • Phone: 646-537-4231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number062498
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: