Provider Demographics
NPI:1669506622
Name:SNEIDER, ESTELLA (PHD)
Entity Type:Individual
Prefix:DR
First Name:ESTELLA
Middle Name:
Last Name:SNEIDER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:ESTELLA
Other - Middle Name:
Other - Last Name:SNEIDER-UMANSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:528 PALISADES DR # 521
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-2844
Mailing Address - Country:US
Mailing Address - Phone:310-467-3288
Mailing Address - Fax:310-230-1903
Practice Address - Street 1:5425 POMONA BLVD
Practice Address - Street 2:
Practice Address - City:EAST LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-1716
Practice Address - Country:US
Practice Address - Phone:323-728-0411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11035103TC0700X
CAMFC021803106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY11035OtherPSYCHOLOGY LICENSE
CAMFC021883OtherMFT LICENSE
CAMFC021883OtherMFT LICENSE
CACP11035Medicare ID - Type Unspecified
CACP11035AMedicare ID - Type Unspecified