Provider Demographics
NPI:1902307077
Name:SNOWBALL, MARQUITAH
Entity Type:Individual
Prefix:
First Name:MARQUITAH
Middle Name:
Last Name:SNOWBALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARQUITAH
Other - Middle Name:
Other - Last Name:SNOWBALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:N/A
Mailing Address - Street 1:45 PARK PL
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-4207
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:126 LIBRARY LN
Practice Address - Street 2:
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-3608
Practice Address - Country:US
Practice Address - Phone:914-670-1156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician