Provider Demographics
NPI:1265491187
Name:SUROWICK-SNYDER, LAURA JEAN (MSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:JEAN
Last Name:SUROWICK-SNYDER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 DOWNS AVE
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-5706
Mailing Address - Country:US
Mailing Address - Phone:304-296-9298
Mailing Address - Fax:
Practice Address - Street 1:720 DOWNS AVE
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-5706
Practice Address - Country:US
Practice Address - Phone:304-296-9298
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVCP00938898104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVW22928OtherWUPIN MT STATE BCBS