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General NPI Number Information
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NPI Number | 1376817429
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Entity Type | Organization
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Legal Business Name | KENT CANDELORA, PHD, A PSYCHOLOGICAL CORPORATION
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Dates
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Enumeration Date | 03/06/2012
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Last Update Date | 03/06/2012
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Provider Practice Location Address
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Address Line | 1530 E CHEVY CHASE DR SUITE 103
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City | GLENDALE
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State | CA
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Zip | 91206-4139
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Country | US
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Telephone | 818-790-0150
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Fax |
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Provider Business Mailing Address
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Address Line | 1530 E CHEVY CHASE DR SUITE 103
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City | GLENDALE
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State | CA
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Zip | 91206-4139
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Country | US
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Telephone | 818-790-0150
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. KENT CANDELORA
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Credential | PH.D.
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Telephone | 818-790-0150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY5341
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License Number State | CA
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