Healthcare Provider Details

I. General information

NPI: 1841176559
Provider Name (Legal Business Name): IVY CHARLOTTE SNYDER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: IVY CHARLOTTE GOSNELL

II. Dates (important events)

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

III. Provider practice location address

760 WESTWOOD PLZ # A7-417
LOS ANGELES CA
90024-5055
US

IV. Provider business mailing address

760 WESTWOOD PLZ # A7-417
LOS ANGELES CA
90024-5055
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-7573
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number35666
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number35666
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number35666
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: