Provider Demographics
NPI:1245347913
Name:SNOW, SANDRA B (PHD, LCSWC)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:B
Last Name:SNOW
Suffix:
Gender:F
Credentials:PHD, LCSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 W 39TH ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-1701
Mailing Address - Country:US
Mailing Address - Phone:410-889-9404
Mailing Address - Fax:410-889-3616
Practice Address - Street 1:3811 CANTERBURY RD
Practice Address - Street 2:DOCTORS OFFICE
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-2340
Practice Address - Country:US
Practice Address - Phone:410-889-9404
Practice Address - Fax:410-889-3616
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD47411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD124461200Medicaid
MD41704703OtherCAREFIRST BCBS
MD41704703OtherCAREFIRST BCBS