Provider Demographics
NPI:1851793137
Name:SNIDER, MINDY (MED)
Entity Type:Individual
Prefix:MRS
First Name:MINDY
Middle Name:
Last Name:SNIDER
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:OH
Mailing Address - Zip Code:45103-2803
Mailing Address - Country:US
Mailing Address - Phone:513-732-0780
Mailing Address - Fax:
Practice Address - Street 1:215 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103-2803
Practice Address - Country:US
Practice Address - Phone:513-732-0780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCI1003744103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool