MEDICARE: ROBERTA LYNN SNOW LCSW, CCM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	1539	OK
2	1041C0700X	Clinical Social Worker	1539	OK

General Provider Information

NPI Number	:	1215189980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERTA LYNN SNOW LCSW, CCM

Provider Business Mailing Address
First Line	:	4800 N MAYFAIR DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-8209
Country	:	US
Telephone Number	:	405-702-1553
Fax Number	:

Provider Business Practice Location Address
First Line	:	4800 N MAYFAIR DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-8209
Country	:	US
Telephone Number	:	405-702-1553
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2008
Last Update Date	:	04/04/2011

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