MEDICARE: DR. C MICHAEL SNYTER PH.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	103TC0700X	Clinical Psychologist	PS004316L	PA

General Provider Information

NPI Number	:	1568450963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. C MICHAEL SNYTER PH.D.

Provider Business Mailing Address
First Line	:	115 E GLENSIDE AVE
Second Line	:	SUITE 16
City	:	GLENSIDE
State	:	PA
Zip	:	19038-4618
Country	:	US
Telephone Number	:	215-572-5400
Fax Number	:	215-572-1555

Provider Business Practice Location Address
First Line	:	115 E GLENSIDE AVE
Second Line	:	SUITE 16
City	:	GLENSIDE
State	:	PA
Zip	:	19038-4618
Country	:	US
Telephone Number	:	215-572-5400
Fax Number	:	215-572-1555

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

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	01/14/2016

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