Provider Demographics
NPI:1104394402
Name:SNYDERMAN, RICHARD B (LPC, CADC, CSAT, NCC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:B
Last Name:SNYDERMAN
Suffix:
Gender:M
Credentials:LPC, CADC, CSAT, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 PENNSYLVANIA AVE STE 1A2
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-3002
Mailing Address - Country:US
Mailing Address - Phone:267-428-2608
Mailing Address - Fax:
Practice Address - Street 1:2401 PENNSYLVANIA AVE STE 1A2
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-3002
Practice Address - Country:US
Practice Address - Phone:267-428-2608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-05
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA101YA0400X
PAPC000172101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)