Provider Demographics
NPI:1982870002
Name:SNIDER, TINA H (PHD)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:H
Last Name:SNIDER
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 1:414 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-2145
Mailing Address - Country:US
Mailing Address - Phone:973-635-5662
Mailing Address - Fax:973-635-5672
Practice Address - Street 1:414 MAIN ST
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928-2145
Practice Address - Country:US
Practice Address - Phone:973-635-5662
Practice Address - Fax:973-635-5672
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC003525300101YM0800X
NJ5109103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
11809113OtherCAQH