Provider Demographics
NPI:1750518429
Name:SNYDER, MELISSA A (LCSW)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:A
Last Name:SNYDER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:CYR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:PO BOX 2453
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04241-2453
Mailing Address - Country:US
Mailing Address - Phone:877-838-5741
Mailing Address - Fax:
Practice Address - Street 1:290 POND RD
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-3326
Practice Address - Country:US
Practice Address - Phone:877-868-5741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-19
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC11383104100000X, 1041C0700X
MELC124651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME433835799Medicaid
001524101Medicare PIN