Healthcare Provider Details

I. General information

NPI: 1164639266
Provider Name (Legal Business Name): SUSAN SNYDER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 AVENIDA DE ORINDA, #100
ORINDA CA
94563
US

IV. Provider business mailing address

1884 JOSEPH DR
MORAGA CA
94556-2711
US

V. Phone/Fax

Practice location:
  • Phone: 925-388-2001
  • Fax:
Mailing address:
  • Phone: 925-388-2001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number10526
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: