Provider Demographics
NPI:1568564920
Name:SNYDER, SUSAN U (PH D)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:U
Last Name:SNYDER
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4204 GORDON COOPER DR
Mailing Address - Street 2:
Mailing Address - City:JAMESVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13078-9781
Mailing Address - Country:US
Mailing Address - Phone:315-378-0872
Mailing Address - Fax:
Practice Address - Street 1:315 S CROUSE AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1845
Practice Address - Country:US
Practice Address - Phone:315-491-0253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000120106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist