Provider Demographics
NPI:1487902599
Name:SNYDER, BETHANY (MSW)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:
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 1:49 SWEET GUM CIR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27332-1346
Mailing Address - Country:US
Mailing Address - Phone:716-969-0175
Mailing Address - Fax:
Practice Address - Street 1:49 SWEET GUM CIR
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27332-1346
Practice Address - Country:US
Practice Address - Phone:716-969-0175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-21
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP006923103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst