Healthcare Provider Details

I. General information

NPI: 1902484215
Provider Name (Legal Business Name): KATE SNYDER KING LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATE SNYDER KING JONES LMSW

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 03/30/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 NOYAC RD BLDG D
SAG HARBOR NY
11963-1931
US

IV. Provider business mailing address

131 MADISON ST
SAG HARBOR NY
11963-4424
US

V. Phone/Fax

Practice location:
  • Phone: 917-900-7475
  • Fax:
Mailing address:
  • Phone: 917-882-2227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number111443
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: