Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | LC12237 | ME |
NPI | 1003157884 |
---|---|
Provider Name | Penelope Faith Snow |
First Address | Kennebunk, ME 04043-6705 |
Second Address | Kennebunk, ME 04043-6705 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2013 |
Last Update Date | 13/09/2021 |