Provider Demographics
NPI:1639837826
Name:SNECKENBERG, KRISTIE (LMHC)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:
Last Name:SNECKENBERG
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:454 REVONAH HILL RD
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:NY
Mailing Address - Zip Code:12754-3319
Mailing Address - Country:US
Mailing Address - Phone:845-590-7504
Mailing Address - Fax:
Practice Address - Street 1:454 REVONAH HILL RD
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:NY
Practice Address - Zip Code:12754-3319
Practice Address - Country:US
Practice Address - Phone:845-590-7504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-04
Last Update Date:2021-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3781-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health