Healthcare Provider Details

I. General information

NPI: 1568450963
Provider Name (Legal Business Name): C MICHAEL SNYTER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 01/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E GLENSIDE AVE SUITE 16
GLENSIDE PA
19038-4618
US

IV. Provider business mailing address

115 E GLENSIDE AVE SUITE 16
GLENSIDE PA
19038-4618
US

V. Phone/Fax

Practice location:
  • Phone: 215-572-5400
  • Fax: 215-572-1555
Mailing address:
  • Phone: 215-572-5400
  • Fax: 215-572-1555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS004316L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: