Provider Demographics
NPI:1497943245
Name:SNELL, STEPHEN C (LCSW)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:C
Last Name:SNELL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 OAKDALE DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-1153
Mailing Address - Country:US
Mailing Address - Phone:585-261-5513
Mailing Address - Fax:
Practice Address - Street 1:1541 MONROE AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-1423
Practice Address - Country:US
Practice Address - Phone:585-261-5513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR033883-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBB5362OtherMEDICARE PROVIDER NUMBER