Healthcare Provider Details

I. General information

NPI: 1053747345
Provider Name (Legal Business Name): JENNIFER M SNYDER PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2013
Last Update Date: 09/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 N COMMERCE PKWY SUITE 200
WESTON FL
33326-3258
US

IV. Provider business mailing address

15821 SW 48TH MNR
MIRAMAR FL
33027-5647
US

V. Phone/Fax

Practice location:
  • Phone: 954-842-3643
  • Fax:
Mailing address:
  • Phone: 305-788-7674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY6961
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY6961
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPY6961
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberPY6961
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberPY6961
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: