Provider Demographics
NPI:1710735436
Name:SNYDER, JULIE MARJORIE (RAD-T)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:MARJORIE
Last Name:SNYDER
Suffix:
Gender:F
Credentials:RAD-T
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:MARJORIE
Other - Last Name:BAYNOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2550 E RIVERSIDE DR APT 191
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-7391
Mailing Address - Country:US
Mailing Address - Phone:951-249-5847
Mailing Address - Fax:
Practice Address - Street 1:1950 E 17TH ST STE 150
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-6852
Practice Address - Country:US
Practice Address - Phone:951-249-5847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-08
Last Update Date:2024-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1560220524106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician