Healthcare Provider Details

I. General information

NPI: 1972831972
Provider Name (Legal Business Name): RICHARD SNAITH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2009
Last Update Date: 12/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39501 N CAROLINA AVE
QUEEN CREEK AZ
85140-5718
US

IV. Provider business mailing address

39501 N CAROLINA AVE
QUEEN CREEK AZ
85140-5718
US

V. Phone/Fax

Practice location:
  • Phone: 623-698-9041
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number3966488
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: