Provider Demographics
NPI:1902484215
Name:SNYDER KING, KATE (LMSW)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:
Last Name:SNYDER KING
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:SNYDER KING
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:131 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:SAG HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11963-4424
Mailing Address - Country:US
Mailing Address - Phone:917-882-2227
Mailing Address - Fax:
Practice Address - Street 1:3330 NOYAC RD BLDG D
Practice Address - Street 2:
Practice Address - City:SAG HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11963-1931
Practice Address - Country:US
Practice Address - Phone:917-900-7475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1114431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1273312OtherCERTIFICATE
NY111443OtherLICENSE NUMBER