Healthcare Provider Details

I. General information

NPI: 1467723460
Provider Name (Legal Business Name): REBECCA LYNNE SNYDER PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2012
Last Update Date: 01/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 THOMAS JOHNSON DR SUITE A
FREDERICK MD
21702-4371
US

IV. Provider business mailing address

65 THOMAS JOHNSON DR SUITE A
FREDERICK MD
21702-4371
US

V. Phone/Fax

Practice location:
  • Phone: 301-682-6639
  • Fax: 301-695-9694
Mailing address:
  • Phone: 301-682-6639
  • Fax: 301-695-9694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2863
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: