MEDICARE: DR. CARMELA JOSEPHINE DECANDIA 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	7805	MA
2	103TC0700X	Clinical Psychologist	017789	NY
3	103TC2200X	Clinical Child & Adolescent Psychologist	7805	MA
4	103TC2200X	Clinical Child & Adolescent Psychologist	017789	NY

General Provider Information

NPI Number	:	1437446739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARMELA JOSEPHINE DECANDIA PSY.D.

Provider Business Mailing Address
First Line	:	24R SCHOOL ST
Second Line	:
City	:	NEWTON
State	:	MA
Zip	:	02458-1518
Country	:	US
Telephone Number	:	617-916-0156
Fax Number	:

Provider Business Practice Location Address
First Line	:	24R SCHOOL ST
Second Line	:
City	:	NEWTON
State	:	MA
Zip	:	02458-1518
Country	:	US
Telephone Number	:	617-916-0156
Fax Number	:

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

Provider Enumeration Date	:	07/07/2011
Last Update Date	:	07/07/2011

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