Healthcare Provider Details

I. General information

NPI: 1235017658
Provider Name (Legal Business Name): LACEY SNYDER PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LACEY BENGTSON

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 08/25/2025
Certification Date: 08/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 MANHEIM PIKE STE 202
LANCASTER PA
17601-3127
US

IV. Provider business mailing address

2 HOLLOW ROCK
LINCOLN UNIVERSITY PA
19352-8943
US

V. Phone/Fax

Practice location:
  • Phone: 717-791-2520
  • Fax:
Mailing address:
  • Phone: 302-260-2696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: