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General NPI Number Information
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NPI Number | 1689297111
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Entity Type | Individual
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Provider Name | JACQUELINE CANDUCI
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Gender | Female
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Dates
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Enumeration Date | 05/19/2020
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Last Update Date | 05/19/2020
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Provider Practice Location Address
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Address Line | 2801 GRANT AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19114-1032
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Country | US
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Telephone | 215-695-4270
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Fax |
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Provider Business Mailing Address
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Address Line | 5200 HILLTOP DR APT CC18
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City | BROOKHAVEN
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State | PA
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Zip | 19015-1261
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Country | US
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Telephone | 856-630-4224
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-20-42077
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License Number State |
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