MEDICARE: MR. WILLIAM CHARLES SNOBERGER M.A.

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	103TC1900X	Counseling Psychologist	603	WV
2	103TM1800X	Intellectual & Developmental Disabilities Psychologist	603	WV
3	103T00000X	Psychologist	603	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700884699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM CHARLES SNOBERGER M.A.

Provider Business Mailing Address
First Line	:	130 CENTER ST
Second Line	:
City	:	KEYSER
State	:	WV
Zip	:	26726-3520
Country	:	US
Telephone Number	:	304-788-1113
Fax Number	:	304-788-2777

Provider Business Practice Location Address
First Line	:	130 CENTER ST
Second Line	:
City	:	KEYSER
State	:	WV
Zip	:	26726-3520
Country	:	US
Telephone Number	:	304-788-1113
Fax Number	:	304-788-2777

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

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	04/24/2019

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