MEDICARE: MR. JOSE A. CANDELARIO-CARMONA JR. LCSW

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	081811	NY

General Provider Information

NPI Number	:	1811202096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSE A. CANDELARIO-CARMONA JR. LCSW

Provider Business Mailing Address
First Line	:	2426 EASTCHESTER RD STE 201
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10469-5950
Country	:	US
Telephone Number	:	347-301-6981
Fax Number	:	866-274-4236

Provider Business Practice Location Address
First Line	:	2426 EASTCHESTER RD STE 201
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10469-5950
Country	:	US
Telephone Number	:	347-301-6981
Fax Number	:

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

Provider Enumeration Date	:	08/12/2010
Last Update Date	:	12/05/2019

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