MEDICARE: CANDACE R. COTTON 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	2325	MD

General Provider Information

NPI Number	:	1831259324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDACE R. COTTON PH.D.

Provider Business Mailing Address
First Line	:	10837 TUCKAHOE WAY
Second Line	:
City	:	NORTH POTOMAC
State	:	MD
Zip	:	20878-4226
Country	:	US
Telephone Number	:	301-279-9066
Fax Number	:	301-279-9548

Provider Business Practice Location Address
First Line	:	10837 TUCKAHOE WAY
Second Line	:
City	:	NORTH POTOMAC
State	:	MD
Zip	:	20878-4226
Country	:	US
Telephone Number	:	301-279-9066
Fax Number	:	301-279-9548

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

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	07/08/2007

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