Healthcare Provider Details

I. General information

NPI: 1619383346
Provider Name (Legal Business Name): LISA SNYDER LMHC, CASAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LISA LAGATTUTA LMHC, CASAC

II. Dates (important events)

Enumeration Date: 07/02/2014
Last Update Date: 07/17/2020
Certification Date: 07/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 GARDEN ST
RHINEBECK NY
12572-1357
US

IV. Provider business mailing address

8 GARDEN ST
RHINEBECK NY
12572-1357
US

V. Phone/Fax

Practice location:
  • Phone: 845-332-4311
  • Fax: 845-795-6279
Mailing address:
  • Phone: 845-332-4311
  • Fax: 845-795-6279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number006053
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: