Provider Demographics
NPI:1043843451
Name:DIAZ-HUNTER, CANDICE LEIGH (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:CANDICE
Middle Name:LEIGH
Last Name:DIAZ-HUNTER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:LEIGH
Other - Last Name:HUNTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:779 ALPINE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01550-3957
Mailing Address - Country:US
Mailing Address - Phone:407-963-2992
Mailing Address - Fax:
Practice Address - Street 1:1 PICKER RD
Practice Address - Street 2:
Practice Address - City:STURBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01566-1252
Practice Address - Country:US
Practice Address - Phone:508-347-8181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-14
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst