Healthcare Provider Details

I. General information

NPI: 1164544078
Provider Name (Legal Business Name): CANDACE SHERBURNE FIRTH PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1417 SE 4TH ST
FORT LAUDERDALE FL
33301-2319
US

IV. Provider business mailing address

108 SPYGLASS LN
JUPITER FL
33477-4037
US

V. Phone/Fax

Practice location:
  • Phone: 561-832-7788
  • Fax: 954-779-1643
Mailing address:
  • Phone: 561-748-1726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT0387
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: