1295944569 NPI number — MS. CANDICE MARIA FEDERICO LMHC, CAP

Table of content: MS. CANDICE MARIA FEDERICO LMHC, CAP (NPI 1295944569)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295944569 NPI number — MS. CANDICE MARIA FEDERICO LMHC, CAP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FEDERICO
Provider First Name:
CANDICE
Provider Middle Name:
MARIA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMHC, CAP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295944569
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P. O. BOX 3281
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOYNTON BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33426-3281
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-676-3488
Provider Business Mailing Address Fax Number:
561-279-2898

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 SE 6TH AVE
Provider Second Line Business Practice Location Address:
STE 206 & 202
Provider Business Practice Location Address City Name:
DELRAY BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33483-5185
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-279-2080
Provider Business Practice Location Address Fax Number:
561-279-2898
Provider Enumeration Date:
05/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  1973 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 101YM0800X , with the licence number: MH 5131 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)





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