=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881785038
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CANDACE S PALLANTE LSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2006
-----------------------------------------------------
Last Update Date | 07/03/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 150 CROSS STREET
-----------------------------------------------------
City | AKRON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44311-1026
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-996-9141
-----------------------------------------------------
Fax | 330-253-0377
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 150 CROSS STREET
-----------------------------------------------------
City | AKRON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44311-1026
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-996-9141
-----------------------------------------------------
Fax | 330-253-0377
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | S0017524
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | RN377690
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------