Healthcare Provider Details

I. General information

NPI: 1982870002
Provider Name (Legal Business Name): TINA H. SNIDER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 09/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 MAIN ST
CHATHAM NJ
07928-2145
US

IV. Provider business mailing address

414 MAIN ST
CHATHAM NJ
07928-2145
US

V. Phone/Fax

Practice location:
  • Phone: 973-635-5662
  • Fax: 973-635-5672
Mailing address:
  • Phone: 973-635-5662
  • Fax: 973-635-5672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37PC003525300
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number5109
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: