Provider Demographics
NPI:1619207933
Name:SNOOK, GERALD E (MA, LLP)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:E
Last Name:SNOOK
Suffix:
Gender:M
Credentials:MA, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1854 W AUBURN RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-3868
Mailing Address - Country:US
Mailing Address - Phone:248-844-1414
Mailing Address - Fax:248-844-2670
Practice Address - Street 1:1854 W AUBURN RD
Practice Address - Street 2:SUITE 400
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-3868
Practice Address - Country:US
Practice Address - Phone:248-844-1414
Practice Address - Fax:248-844-2670
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-08
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008244103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical