Healthcare Provider Details

I. General information

NPI: 1497371702
Provider Name (Legal Business Name): MAUREEN SNYDER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2020
Last Update Date: 06/23/2020
Certification Date: 06/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BUILDING 1122
CAMP PENDELTON CA
92055
US

IV. Provider business mailing address

32565 GOLDEN LANTERN ST STE B
DANA POINT CA
92629-3261
US

V. Phone/Fax

Practice location:
  • Phone: 484-883-3089
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCWO14318
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: