Provider Demographics
NPI:1174851778
Name:CANDAN, KRISTIN ANI (PHD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:ANI
Last Name:CANDAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7559 263RD ST
Mailing Address - Street 2:RAP PROGRAM
Mailing Address - City:GLEN OAKS
Mailing Address - State:NY
Mailing Address - Zip Code:11004-1150
Mailing Address - Country:US
Mailing Address - Phone:718-470-4238
Mailing Address - Fax:718-470-8131
Practice Address - Street 1:7559 263RD ST
Practice Address - Street 2:RAP PROGRAM
Practice Address - City:GLEN OAKS
Practice Address - State:NY
Practice Address - Zip Code:11004-1150
Practice Address - Country:US
Practice Address - Phone:718-470-4238
Practice Address - Fax:718-470-8131
Is Sole Proprietor?:No
Enumeration Date:2009-11-20
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018316103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical