| Lisa J. Snow, Lcsw, Llc | |
|
314 E Promenade St Mexico MO 65265-2857 | |
| (573) 975-4301 | |
| (573) 975-4304 |
| Full Name | Lisa J. Snow, Lcsw, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 314 E Promenade St, Mexico, Missouri |
| Authorized Official Name and Position | Lisa Snow (PROVIDER) |
| Authorized Official Contact | 5739754301 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lisa J. Snow, Lcsw, Llc 314 E Promenade St Mexico MO 65265-2857 Ph: (573) 975-4301 | Lisa J. Snow, Lcsw, Llc 314 E Promenade St Mexico MO 65265-2857 Ph: (573) 975-4301 |
| NPI Number | 1013381276 |
|---|---|
| Provider Enumeration Date | 11/25/2015 |
| Last Update Date | 12/17/2023 |
| Certification Date | 12/17/2023 |
| Medicare PECOS PAC ID | 2163721283 |
|---|---|
| Medicare Enrollment ID | O20160425000817 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013381276 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 2013025364 (Missouri) | Primary |
| Provider Name | Lisa J Snow |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750705638 PECOS PAC ID: 3274851209 Enrollment ID: I20150423000109 |
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