Provider Demographics
NPI:1780758128
Name:SNIDER, SUSAN LEIGH (LISW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:LEIGH
Last Name:SNIDER
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 PEARL RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-3448
Mailing Address - Country:US
Mailing Address - Phone:330-220-3611
Mailing Address - Fax:330-558-0211
Practice Address - Street 1:1380 PEARL RD
Practice Address - Street 2:SUITE 206
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-3448
Practice Address - Country:US
Practice Address - Phone:330-220-3611
Practice Address - Fax:330-558-0211
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 90811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical