Provider Demographics
NPI:1992889398
Name:SNYDER, CRAIG DALLAS (PHD)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:DALLAS
Last Name:SNYDER
Suffix:
Gender:M
Credentials:PHD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2337 ROSCOMARE RD
Mailing Address - Street 2:#2-353
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1854
Mailing Address - Country:US
Mailing Address - Phone:310-612-0035
Mailing Address - Fax:310-471-0035
Practice Address - Street 1:8730 WILSHIRE BLVD
Practice Address - Street 2:SUITE# 210
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2716
Practice Address - Country:US
Practice Address - Phone:310-612-0035
Practice Address - Fax:310-471-0035
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY15857103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS67505Medicare UPIN
CACP15857Medicare ID - Type Unspecified