Healthcare Provider Details

I. General information

NPI: 1124225545
Provider Name (Legal Business Name): VICTORIA LEAH SNYDER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12815 HEACOCK ST
MORENO VALLEY CA
92553-3116
US

IV. Provider business mailing address

7046 ESPANA DR
RIVERSIDE CA
92504-4856
US

V. Phone/Fax

Practice location:
  • Phone: 951-601-6174
  • Fax: 951-601-6224
Mailing address:
  • Phone: 951-601-6191
  • Fax: 951-601-6224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17185
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: