Provider Demographics
NPI:1831704790
Name:SNAPPER, KIMBERLY (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:SNAPPER
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 81087
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY HILLS
Mailing Address - State:MA
Mailing Address - Zip Code:02481-0001
Mailing Address - Country:US
Mailing Address - Phone:201-906-1199
Mailing Address - Fax:
Practice Address - Street 1:76 BEDFORD ST STE 25
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-4641
Practice Address - Country:US
Practice Address - Phone:201-906-1199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1224821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA122482OtherLICSW- SOCIAL WORK LICENSE