Provider Demographics
NPI:1215381355
Name:SNYDER, TINA M (LCSW)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:M
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 1:1654 WEST ONONDAGA STREET
Mailing Address - Street 2:CATHOLIC CHARITIES OF ONONDAGA COUNTY
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204
Mailing Address - Country:US
Mailing Address - Phone:315-362-7562
Mailing Address - Fax:315-424-6079
Practice Address - Street 1:1654 W ONONDAGA ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13204-3310
Practice Address - Country:US
Practice Address - Phone:315-362-7562
Practice Address - Fax:315-424-6079
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-14
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY087326104100000X
NY0850981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker