Healthcare Provider Details

I. General information

NPI: 1124181623
Provider Name (Legal Business Name): STEPHANIE LYNN SNYDER MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 01/03/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1761 BROADWAY ST
VALLEJO CA
94589-2226
US

IV. Provider business mailing address

2018 COOMBSVILLE RD
NAPA CA
94558-3916
US

V. Phone/Fax

Practice location:
  • Phone: 707-645-2452
  • Fax:
Mailing address:
  • Phone: 707-224-8537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC37876
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: