Provider Demographics
NPI:1124186895
Name:DEPUY, CANDACE L (PHD)
Entity Type:Individual
Prefix:DR
First Name:CANDACE
Middle Name:L
Last Name:DEPUY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18034 VENTURA BLVD
Mailing Address - Street 2:PMB422
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3516
Mailing Address - Country:US
Mailing Address - Phone:818-789-3428
Mailing Address - Fax:818-787-5870
Practice Address - Street 1:15720 VENTURA BLVD
Practice Address - Street 2:STE 303
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436
Practice Address - Country:US
Practice Address - Phone:818-789-3428
Practice Address - Fax:818-787-5870
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASW15845104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASW15845Medicare ID - Type Unspecified