Provider Demographics
NPI:1932334760
Name:SNYDER, ROBERT R (MFTI)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:R
Last Name:SNYDER
Suffix:
Gender:M
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9730 CABANAS AVE
Mailing Address - Street 2:
Mailing Address - City:TUJUNGA
Mailing Address - State:CA
Mailing Address - Zip Code:91042-2925
Mailing Address - Country:US
Mailing Address - Phone:818-352-1295
Mailing Address - Fax:
Practice Address - Street 1:9730 CABANAS AVE
Practice Address - Street 2:
Practice Address - City:TUJUNGA
Practice Address - State:CA
Practice Address - Zip Code:91042-2925
Practice Address - Country:US
Practice Address - Phone:818-352-1295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-22
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABBS REG. #57032106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA57032OtherCALIFORNIA BOARD OF BEHAVIORAL SCIENCES REGISTRATION #