Provider Demographics
NPI:1104993575
Name:SNYDER, SARA BROOKE (MSW)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:BROOKE
Last Name:SNYDER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 MAIN ST
Mailing Address - Street 2:PO BOX 182
Mailing Address - City:CENTERBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06409-1001
Mailing Address - Country:US
Mailing Address - Phone:860-767-2266
Mailing Address - Fax:860-767-5067
Practice Address - Street 1:68 MAIN ST
Practice Address - Street 2:
Practice Address - City:CENTERBROOK
Practice Address - State:CT
Practice Address - Zip Code:06409-1001
Practice Address - Country:US
Practice Address - Phone:860-767-2266
Practice Address - Fax:860-767-5067
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0045501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical