Provider Demographics
NPI:1427278191
Name:SNELL, AMY ELIZABETH (LICSW)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:ELIZABETH
Last Name:SNELL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130
Mailing Address - Country:US
Mailing Address - Phone:617-524-1496
Mailing Address - Fax:
Practice Address - Street 1:332 HANOVER STREET
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02113
Practice Address - Country:US
Practice Address - Phone:617-643-8080
Practice Address - Fax:617-643-8127
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1026384104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker