Healthcare Provider Details

I. General information

NPI: 1134830649
Provider Name (Legal Business Name): COURTNEY SNYDERMAN M.S., LBS, RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2022
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 WEST BALTIMORE PIKE SUITE 100 B
MEDIA PA
19063
US

IV. Provider business mailing address

77 WEST BALTIMORE PIKE SUITE 100 B
MEDIA PA
19063
US

V. Phone/Fax

Practice location:
  • Phone: 610-572-5520
  • Fax: 610-572-5521
Mailing address:
  • Phone: 610-572-5520
  • Fax: 610-572-5521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBH006276
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-196814
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: