Healthcare Provider Details

I. General information

NPI: 1457772147
Provider Name (Legal Business Name): CANDYCE TART PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2013
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4810 HARDWARE DR NE STE 4
ALBUQUERQUE NM
87109-2013
US

IV. Provider business mailing address

607 RICHMOND DR NE
ALBUQUERQUE NM
87106-2148
US

V. Phone/Fax

Practice location:
  • Phone: 505-805-2912
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1312
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1312
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: