Provider Demographics
NPI:1629016738
Name:SNELSON, DEBORAH L (MA)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
Last Name:SNELSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 TYLER CT
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013-7671
Mailing Address - Country:US
Mailing Address - Phone:717-249-1033
Mailing Address - Fax:717-245-9036
Practice Address - Street 1:2 TYLER CT
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-7671
Practice Address - Country:US
Practice Address - Phone:717-249-1033
Practice Address - Fax:717-245-9036
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA004860L103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02324000OtherCAPITAL BLUE CROSS
PA88922500OtherHIGHMARK BLUE SHIELD
11451083OtherCAQH