Provider Demographics
NPI:1063577658
Name:SNIDER, PAMELA R (PHD)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:R
Last Name:SNIDER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4754 WOODMERE BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106
Mailing Address - Country:US
Mailing Address - Phone:334-356-8430
Mailing Address - Fax:334-356-8413
Practice Address - Street 1:4754 WOODMERE BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106
Practice Address - Country:US
Practice Address - Phone:334-356-8430
Practice Address - Fax:334-356-8413
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL753103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALPLAN #510OtherBLUE CROSS BLUE SHIELD
ALPLAN #74611OtherBLUE CROSS BLUE SHIELD