Healthcare Provider Details

I. General information

NPI: 1548283971
Provider Name (Legal Business Name): NERIZA S. CANDELARIO LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 12/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 LIBERTY HEIGHTS AVE. SUITE 111
BALTIMORE MD
21215
US

IV. Provider business mailing address

1501 DIVISION STREET
BALTIMORE MD
21217-3121
US

V. Phone/Fax

Practice location:
  • Phone: 410-383-8300
  • Fax:
Mailing address:
  • Phone: 410-383-8300
  • Fax: 410-728-4732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13535
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: