Provider Demographics
NPI:1205079928
Name:FAUSTIN, SNYDER (BCABA)
Entity type:Individual
Prefix:MS
First Name:SNYDER
Middle Name:
Last Name:FAUSTIN
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 FORTENBERRY RD
Mailing Address - Street 2:SUITE B4
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-3601
Mailing Address - Country:US
Mailing Address - Phone:321-863-5286
Mailing Address - Fax:321-745-2720
Practice Address - Street 1:255 FORTENBERRY RD
Practice Address - Street 2:SUITE B4
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-3601
Practice Address - Country:US
Practice Address - Phone:321-863-5286
Practice Address - Fax:321-745-2720
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-10
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-03-0961103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst