MEDICARE: DR. JENNIFER M SNYDER PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PY6961	FL
2	103TC0700X	Clinical Psychologist	PY6961	FL
3	103TC2200X	Clinical Child & Adolescent Psychologist	PY6961	FL
4	103TP2701X	Group Psychotherapy Psychologist	PY6961	FL
5	103TS0200X	School Psychologist	PY6961	FL

General Provider Information

NPI Number	:	1053747345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER M SNYDER PSY.D.

Provider Business Mailing Address
First Line	:	15821 SW 48TH MNR
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33027-5647
Country	:	US
Telephone Number	:	305-788-7674
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 N COMMERCE PKWY
Second Line	:	SUITE 200
City	:	WESTON
State	:	FL
Zip	:	33326-3258
Country	:	US
Telephone Number	:	954-842-3643
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2013
Last Update Date	:	09/19/2013

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