Provider Demographics
NPI:1962563304
Name:SNYDER, PHILLIP D (PHD)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:D
Last Name:SNYDER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 E GREEN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-2401
Mailing Address - Country:US
Mailing Address - Phone:626-793-7792
Mailing Address - Fax:626-793-7797
Practice Address - Street 1:960 E GREEN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-2401
Practice Address - Country:US
Practice Address - Phone:626-793-7792
Practice Address - Fax:626-793-7797
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9930103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY0099300Medicaid
CACP9930Medicare ID - Type Unspecified