Healthcare Provider Details

I. General information

NPI: 1114620424
Provider Name (Legal Business Name): REBECCA S SNYDER LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2023
Last Update Date: 03/24/2023
Certification Date: 03/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 W WHITE HORSE PIKE
BERLIN NJ
08009-2028
US

IV. Provider business mailing address

1095 ALMOND RD
PITTSGROVE NJ
08318-3951
US

V. Phone/Fax

Practice location:
  • Phone: 856-352-5424
  • Fax:
Mailing address:
  • Phone: 856-207-0387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: