Provider Demographics
NPI:1093936270
Name:SNYDER, SUSAN JO (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:JO
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:BLUEGRASS HEALTH PSYCHOLOGY, INC.
Mailing Address - Street 2:4101 TATES CREEK CTR DR, STE 150 PMB 123
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-3066
Mailing Address - Country:US
Mailing Address - Phone:859-277-1008
Mailing Address - Fax:859-277-1083
Practice Address - Street 1:BLUEGRASS HEALTH PSYCHOLOGY, INC.
Practice Address - Street 2:2220 YOUNG DRIVE
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40505-4219
Practice Address - Country:US
Practice Address - Phone:859-277-1008
Practice Address - Fax:859-277-1083
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100320410Medicaid