Provider Demographics
NPI:1104188663
Name:SNELL, GEORGIANNE T
Entity Type:Individual
Prefix:
First Name:GEORGIANNE
Middle Name:T
Last Name:SNELL
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 1:325 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:NY
Mailing Address - Zip Code:13340-3622
Mailing Address - Country:US
Mailing Address - Phone:315-717-7442
Mailing Address - Fax:315-895-0062
Practice Address - Street 1:325 5TH AVE
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:NY
Practice Address - Zip Code:13340-3622
Practice Address - Country:US
Practice Address - Phone:315-717-7442
Practice Address - Fax:315-895-0062
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No174400000XOther Service ProvidersSpecialist