Healthcare Provider Details

I. General information

NPI: 1265491187
Provider Name (Legal Business Name): LAURA JEAN SUROWICK-SNYDER MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 DOWNS AVE
MORGANTOWN WV
26505-5706
US

IV. Provider business mailing address

720 DOWNS AVE
MORGANTOWN WV
26505-5706
US

V. Phone/Fax

Practice location:
  • Phone: 304-296-9298
  • Fax:
Mailing address:
  • Phone: 304-296-9298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberCP00938898
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: