Provider Demographics
NPI:1053322008
Name:SNYDER, LAURIE EBERLE (LCSW)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:EBERLE
Last Name:SNYDER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 FOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19056-1915
Mailing Address - Country:US
Mailing Address - Phone:267-994-3616
Mailing Address - Fax:
Practice Address - Street 1:1 OXFORD VLY
Practice Address - Street 2:SUITE 815
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1830
Practice Address - Country:US
Practice Address - Phone:215-750-6310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0132751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASN640615Medicare ID - Type Unspecified