Healthcare Provider Details

I. General information

NPI: 1801863246
Provider Name (Legal Business Name): RICARDO ANTHONY SNYDER LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RICK ANTHONY SNYDER MA

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 06/25/2021
Certification Date: 06/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4375 US HIGHWAY 17 STE 103
FLEMING ISLAND FL
32003-4832
US

IV. Provider business mailing address

85 DEBARRY AVE APT 3051
ORANGE PARK FL
32073-2363
US

V. Phone/Fax

Practice location:
  • Phone: 904-269-0886
  • Fax: 904-269-0499
Mailing address:
  • Phone: 804-516-6683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT4025
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: