Provider Demographics
NPI:1962610261
Name:SNIDER, BEVERLY (MA LBSW)
Entity type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:
Last Name:SNIDER
Suffix:
Gender:F
Credentials:MA LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 E JEFFERSON AVE
Mailing Address - Street 2:311
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48214-3974
Mailing Address - Country:US
Mailing Address - Phone:313-894-8444
Mailing Address - Fax:313-899-4554
Practice Address - Street 1:1852 W GRAND BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48208-1006
Practice Address - Country:US
Practice Address - Phone:313-894-8444
Practice Address - Fax:313-894-5542
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802066513101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)