Provider Demographics
NPI:1821165168
Name:SNELL, MOLLY M (PHD)
Entity Type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:M
Last Name:SNELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 N TROPIC LN
Mailing Address - Street 2:UNIT D
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960
Mailing Address - Country:US
Mailing Address - Phone:772-978-1200
Mailing Address - Fax:772-978-1215
Practice Address - Street 1:570 N TROPIC LN
Practice Address - Street 2:UNIT D
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960
Practice Address - Country:US
Practice Address - Phone:772-978-1200
Practice Address - Fax:772-978-1215
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0002615103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75589Medicare ID - Type Unspecified