Healthcare Provider Details

I. General information

NPI: 1841430592
Provider Name (Legal Business Name): CAROLYN CASTELLO SNYDER MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2009
Last Update Date: 11/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3606 NICHOLAS ST UNIT C
EASTON PA
18045-5100
US

IV. Provider business mailing address

3606 NICHOLAS ST UNIT C
EASTON PA
18045-5100
US

V. Phone/Fax

Practice location:
  • Phone: 484-819-0771
  • Fax: 610-438-4906
Mailing address:
  • Phone: 484-819-0771
  • Fax: 610-438-4906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44S105449100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW016440
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05452700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: