Healthcare Provider Details

I. General information

NPI: 1437714060
Provider Name (Legal Business Name): AMY SNYDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2019
Last Update Date: 05/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1019 GAYLEY AVE FL 2
LOS ANGELES CA
90024-3437
US

IV. Provider business mailing address

21464 PROVIDENCIA ST
WOODLAND HILLS CA
91364-4308
US

V. Phone/Fax

Practice location:
  • Phone: 424-273-8900
  • Fax:
Mailing address:
  • Phone: 323-719-1454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number30802
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: