MEDICARE: DR. CANDICE DONNA SAKETKOO PH.D., PSY.D.

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	103TC0700X	Clinical Psychologist	PY 7045	FL

General Provider Information

NPI Number	:	1407091275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CANDICE DONNA SAKETKOO PH.D., PSY.D.

Provider Business Mailing Address
First Line	:	160 CONGRESS PARK DR
Second Line	:	SUITE 210
City	:	DELRAY BEACH
State	:	FL
Zip	:	33445-4724
Country	:	US
Telephone Number	:	561-445-2028
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 CONGRESS PARK DR
Second Line	:	SUITE 210
City	:	DELRAY BEACH
State	:	FL
Zip	:	33445-4724
Country	:	US
Telephone Number	:	561-445-2028
Fax Number	:

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

Provider Enumeration Date	:	12/09/2008
Last Update Date	:	07/21/2014

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