MEDICARE: MCCANDLESS PETTY

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	90144	CA
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1457767303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MCCANDLESS PETTY

Provider Business Mailing Address
First Line	:	2456 LAFAYETTE RD
Second Line	:
City	:	PORTSMOUTH
State	:	NH
Zip	:	03801-5624
Country	:	US
Telephone Number	:	415-322-8812
Fax Number	:

Provider Business Practice Location Address
First Line	:	2456 LAFAYETTE RD
Second Line	:
City	:	PORTSMOUTH
State	:	NH
Zip	:	03801-5624
Country	:	US
Telephone Number	:	415-322-8812
Fax Number	:

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

Provider Enumeration Date	:	07/10/2014
Last Update Date	:	09/11/2025

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Directions to “ MCCANDLESS PETTY ” Practice Location

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