Provider Demographics
NPI:1235601535
Name:FARRELL, CANDACE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CANDACE
Middle Name:
Last Name:FARRELL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1342 N HAYWORTH AVE APT 201
Mailing Address - Street 2:
Mailing Address - City:W HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-4692
Mailing Address - Country:US
Mailing Address - Phone:323-896-2600
Mailing Address - Fax:
Practice Address - Street 1:1342 N HAYWORTH AVE APT 201
Practice Address - Street 2:
Practice Address - City:W HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-4692
Practice Address - Country:US
Practice Address - Phone:323-896-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-26
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY30573103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY30573OtherPSYCHOLOGIST LICENSE