Healthcare Provider Details

I. General information

NPI: 1053410779
Provider Name (Legal Business Name): DONNA M SNYDER LCSW, CAC DIPLOMATE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 06/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 SASSAFRAS ST SUITE 100
ERIE PA
16502-2716
US

IV. Provider business mailing address

12635 PLANK RD
WATERFORD PA
16441-9023
US

V. Phone/Fax

Practice location:
  • Phone: 814-452-5490
  • Fax: 814-452-7610
Mailing address:
  • Phone: 814-860-5036
  • Fax: 814-860-5063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW013311
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number4586 CAC DIPLOMATE
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: