Provider Demographics
NPI:1699823294
Name:SNYDER, JANE C (PHD)
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:C
Last Name:SNYDER
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 1:40 HINCKLEY RD
Mailing Address - Street 2:
Mailing Address - City:WABAN
Mailing Address - State:MA
Mailing Address - Zip Code:02468-1724
Mailing Address - Country:US
Mailing Address - Phone:617-964-2106
Mailing Address - Fax:617-964-2106
Practice Address - Street 1:1581 BEACON ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-4602
Practice Address - Country:US
Practice Address - Phone:617-232-8016
Practice Address - Fax:617-964-2106
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3185103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW03596Medicare UPIN
MAW03596Medicare ID - Type Unspecified