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General NPI Number Information
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NPI Number | 1962875674
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Entity Type | Individual
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Provider Name | CANDICE LANELL BAIN MT-BC, PSYD
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Gender | Female
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Dates
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Enumeration Date | 11/03/2015
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 1918 UNIVERSITY AVE STE 2B
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City | BERKELEY
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State | CA
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Zip | 94704-3264
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Country | US
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Telephone | 510-548-9716
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Fax |
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Provider Business Mailing Address
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Address Line | 1918 UNIVERSITY AVE STE 2B
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City | BERKELEY
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State | CA
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Zip | 94704-3264
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Country | US
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Telephone |
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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 | 225A00000X
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Taxonomy Name | Music Therapist
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License Number | 12038
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 35340
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 35340
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License Number State | CA
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