MEDICARE: MRS. CANDICE PROUDFOOT UNGER RN, LMHC

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	101YM0800X	Mental Health Counselor	18001293	NY
2	163W00000X	Registered Nurse	22223666	NY

General Provider Information

NPI Number	:	1841362787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CANDICE PROUDFOOT UNGER RN, LMHC

Provider Business Mailing Address
First Line	:	290 WOODWARD AVE
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14214-1905
Country	:	US
Telephone Number	:	716-838-1977
Fax Number	:

Provider Business Practice Location Address
First Line	:	290 WOODWARD AVE
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14214-1905
Country	:	US
Telephone Number	:	716-833-6084
Fax Number	:

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

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	09/11/2025

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