MEDICARE: DENISE JEAN CANDIDI LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	PC006237	PA

General Provider Information

NPI Number	:	1669744421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE JEAN CANDIDI LPC

Provider Business Mailing Address
First Line	:	2605 EGYPT RD
Second Line	:	SUITE 201
City	:	TROOPER
State	:	PA
Zip	:	19403-2317
Country	:	US
Telephone Number	:	484-849-1482
Fax Number	:	610-279-2375

Provider Business Practice Location Address
First Line	:	2605 EGYPT RD
Second Line	:	SUITE 201
City	:	TROOPER
State	:	PA
Zip	:	19403-2317
Country	:	US
Telephone Number	:	484-849-1482
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2012
Last Update Date	:	03/14/2015

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