Provider Demographics
NPI:1164501847
Name:SNYDER, KEVIN W (LISW)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:W
Last Name:SNYDER
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:832 MCKINLEY AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44703-2463
Mailing Address - Country:US
Mailing Address - Phone:330-452-9812
Mailing Address - Fax:330-430-1288
Practice Address - Street 1:832 MCKINLEY AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44703-2463
Practice Address - Country:US
Practice Address - Phone:330-452-9812
Practice Address - Fax:330-430-1288
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0009402101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSNSW30811Medicare PIN