Provider Demographics
NPI:1962591792
Name:PHILLIPS-SNYDER, KIMBERLY MARIE (MSW)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:MARIE
Last Name:PHILLIPS-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 1:975 OKLAHOMA ST
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-9104
Mailing Address - Country:US
Mailing Address - Phone:407-588-2170
Mailing Address - Fax:407-588-2171
Practice Address - Street 1:975 OKLAHOMA ST
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9104
Practice Address - Country:US
Practice Address - Phone:407-588-2170
Practice Address - Fax:407-588-2171
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW 3980104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker