1164706560 NPI number — COMMONWEALTH CASE MANAGEMENT, LLC

Table of content: ROBERT JOSEPH SNYDER LCSW (NPI 1023864105)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164706560 NPI number — COMMONWEALTH CASE MANAGEMENT, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMONWEALTH CASE MANAGEMENT, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164706560
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
199 SILVERDUST CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTICELLO
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42633-3821
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-340-8108
Provider Business Mailing Address Fax Number:
606-679-1234

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
199 SILVERDUST CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTICELLO
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42633-3821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-340-8108
Provider Business Practice Location Address Fax Number:
606-679-1234
Provider Enumeration Date:
10/04/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MCCRACKEN
Authorized Official First Name:
CARRIE
Authorized Official Middle Name:
SHANNON
Authorized Official Title or Position:
OWNER/EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
606-271-3555

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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