Provider Demographics
NPI:1043769714
Name:SNYDER, JANE
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:SNYDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 VT ROUTE 15
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:VT
Mailing Address - Zip Code:05465-2107
Mailing Address - Country:US
Mailing Address - Phone:802-503-2217
Mailing Address - Fax:
Practice Address - Street 1:3367 SPEAR ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:VT
Practice Address - Zip Code:05445-9204
Practice Address - Country:US
Practice Address - Phone:802-503-2217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-23
Last Update Date:2024-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0135721101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty