Healthcare Provider Details

I. General information

NPI: 1427767888
Provider Name (Legal Business Name): MS. CRYSTELLE SNYDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2022
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12001 W WASHINGTON BLVD
LOS ANGELES CA
90066-5801
US

IV. Provider business mailing address

PO BOX 70694
PASADENA CA
91117-7694
US

V. Phone/Fax

Practice location:
  • Phone: 818-414-5034
  • Fax:
Mailing address:
  • Phone: 818-414-5034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW104383
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW127716
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: