Provider Demographics
NPI:1013070598
Name:SNIPES, CHARLENE ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:ANN
Last Name:SNIPES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CHARLENE
Other - Middle Name:
Other - Last Name:SNIPES WALKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:500 VINE STREET
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06112
Mailing Address - Country:US
Mailing Address - Phone:860-297-0905
Mailing Address - Fax:860-297-0914
Practice Address - Street 1:500 VINE STREET
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06112
Practice Address - Country:US
Practice Address - Phone:860-297-0905
Practice Address - Fax:860-297-0914
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT50441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical