MEDICARE: MS. CANDACE C THORNTON LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	1015680	MA

General Provider Information

NPI Number	:	1255496428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CANDACE C THORNTON LICSW

Provider Business Mailing Address
First Line	:	57 WILLOW RD
Second Line	:
City	:	NAHANT
State	:	MA
Zip	:	01908-1306
Country	:	US
Telephone Number	:	781-595-1190
Fax Number	:

Provider Business Practice Location Address
First Line	:	84 HIGHLAND AVE
Second Line	:	SUITE 310
City	:	SALEM
State	:	MA
Zip	:	01970-2727
Country	:	US
Telephone Number	:	781-595-1190
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	07/08/2007

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