Provider Demographics
NPI:1396821252
Name:KANDEL, NINA G (LCSW)
Entity Type:Individual
Prefix:MS
First Name:NINA
Middle Name:G
Last Name:KANDEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 COLGATE LN
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-2218
Mailing Address - Country:US
Mailing Address - Phone:516-921-7329
Mailing Address - Fax:516-921-7328
Practice Address - Street 1:18 COLGATE LN
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-2218
Practice Address - Country:US
Practice Address - Phone:516-921-7329
Practice Address - Fax:516-921-7328
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-024707-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN25441Medicare ID - Type Unspecified