Healthcare Provider Details

I. General information

NPI: 1992064638
Provider Name (Legal Business Name): ASHLEY C SNYDER PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2012
Last Update Date: 08/04/2023
Certification Date: 04/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2204 GARNET AVE STE 204A
SAN DIEGO CA
92109-3771
US

IV. Provider business mailing address

2001 OLIVER AVE
SAN DIEGO CA
92109-5536
US

V. Phone/Fax

Practice location:
  • Phone: 413-446-3725
  • Fax:
Mailing address:
  • Phone: 413-446-3725
  • Fax: 310-840-7023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number33244
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: