Provider Demographics
NPI:1245213487
Name:WEIGLE-SPIER, CANDICE L (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CANDICE
Middle Name:L
Last Name:WEIGLE-SPIER
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 1:770 SAYBROOK RD
Mailing Address - Street 2:BUILDING B
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-4739
Mailing Address - Country:US
Mailing Address - Phone:860-349-0385
Mailing Address - Fax:860-343-5391
Practice Address - Street 1:770 SAYBROOK RD
Practice Address - Street 2:BUILDING B
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-4739
Practice Address - Country:US
Practice Address - Phone:860-349-0385
Practice Address - Fax:860-343-5391
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002044103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004167450Medicaid
CTS90739Medicare UPIN
CT004167450Medicaid