Healthcare Provider Details

I. General information

NPI: 1245487867
Provider Name (Legal Business Name): EDWARD W SNYDER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2008
Last Update Date: 08/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3011 HYDER AVE SE
ALBUQUERQUE NM
87106-2331
US

IV. Provider business mailing address

3011 HYDER AVE SE
ALBUQUERQUE NM
87106-2331
US

V. Phone/Fax

Practice location:
  • Phone: 505-265-8274
  • Fax:
Mailing address:
  • Phone: 505-265-8274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2938
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: