MEDICARE: DR. PAUL LOUIS CANDIDO PH.D.

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	103TC0700X	Clinical Psychologist	0480000412	VT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790885846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL LOUIS CANDIDO PH.D.

Provider Business Mailing Address
First Line	:	145 PINE HAVEN SHORES RD
Second Line	:	SUITE 2032
City	:	SHELBURNE
State	:	VT
Zip	:	05482-7703
Country	:	US
Telephone Number	:	802-864-4513
Fax Number	:	802-985-5061

Provider Business Practice Location Address
First Line	:	145 PINE HAVEN SHORES RD
Second Line	:	SUITE 2032
City	:	SHELBURNE
State	:	VT
Zip	:	05482-7703
Country	:	US
Telephone Number	:	802-864-4513
Fax Number	:	802-985-5061

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

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	07/08/2007

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