Provider Demographics
NPI:1235302811
Name:SNITKIN, JEREMY M (MFT)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:M
Last Name:SNITKIN
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:873 TAMALPAIS AVE
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-3064
Mailing Address - Country:US
Mailing Address - Phone:415-717-9945
Mailing Address - Fax:
Practice Address - Street 1:300 PROFESSIONAL CENTER DR
Practice Address - Street 2:SUITE 322
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947-4334
Practice Address - Country:US
Practice Address - Phone:415-717-9945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-04
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC41494106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC41494OtherCALIFORNIA BBS