Healthcare Provider Details

I. General information

NPI: 1992889398
Provider Name (Legal Business Name): CRAIG DALLAS SNYDER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8730 WILSHIRE BLVD SUITE# 210
BEVERLY HILLS CA
90211-2716
US

IV. Provider business mailing address

2337 ROSCOMARE RD #2-353
LOS ANGELES CA
90077-1854
US

V. Phone/Fax

Practice location:
  • Phone: 310-612-0035
  • Fax: 310-471-0035
Mailing address:
  • Phone: 310-612-0035
  • Fax: 310-471-0035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY15857
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: