Provider Demographics
NPI:1396864344
Name:HAHN, CANDICE (MA)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:
Last Name:HAHN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-2778
Mailing Address - Country:US
Mailing Address - Phone:508-821-7777
Mailing Address - Fax:508-822-2601
Practice Address - Street 1:70 MAIN ST
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-2778
Practice Address - Country:US
Practice Address - Phone:508-821-7777
Practice Address - Fax:508-822-2601
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1309161Medicaid