Provider Demographics
NPI:1902875545
Name:SNYDER, BRUCE E (MS)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:E
Last Name:SNYDER
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 TARA DR
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-8810
Mailing Address - Country:US
Mailing Address - Phone:570-629-4085
Mailing Address - Fax:
Practice Address - Street 1:117 BROAD ST
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-1534
Practice Address - Country:US
Practice Address - Phone:570-424-6049
Practice Address - Fax:570-424-0917
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004106L103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA454295OtherBLUE CROSS PROVIDER #
PA5879430OtherAETNA PROV #
PA77476000OtherMAGELLAN PROV #
PA054140OtherFPH PROV #