Provider Demographics
NPI:1568450963
Name:SNYTER, C MICHAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:C
Middle Name:MICHAEL
Last Name:SNYTER
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 1:115 E GLENSIDE AVE
Mailing Address - Street 2:SUITE 16
Mailing Address - City:GLENSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:19038-4618
Mailing Address - Country:US
Mailing Address - Phone:215-572-5400
Mailing Address - Fax:215-572-1555
Practice Address - Street 1:115 E GLENSIDE AVE
Practice Address - Street 2:SUITE 16
Practice Address - City:GLENSIDE
Practice Address - State:PA
Practice Address - Zip Code:19038-4618
Practice Address - Country:US
Practice Address - Phone:215-572-5400
Practice Address - Fax:215-572-1555
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004316L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASN0088676Medicare ID - Type Unspecified