Provider Demographics
NPI:1407091275
Name:SAKETKOO, CANDICE DONNA (PHD, PSYD)
Entity Type:Individual
Prefix:DR
First Name:CANDICE
Middle Name:DONNA
Last Name:SAKETKOO
Suffix:
Gender:F
Credentials:PHD, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 CONGRESS PARK DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-4724
Mailing Address - Country:US
Mailing Address - Phone:561-445-2028
Mailing Address - Fax:
Practice Address - Street 1:160 CONGRESS PARK DR
Practice Address - Street 2:SUITE 210
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-4724
Practice Address - Country:US
Practice Address - Phone:561-445-2028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-09
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 7045103TC0700X, 103TA0400X, 103TA0700X, 103TB0200X, 103TC0700X, 103TF0000X, 103TH0004X, 103TH0100X, 103TP2701X, 103TR0400X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBQ284YMedicare PIN
FLPY 7045OtherFLORIDA BOARD OF PSYCHOLOGY LISCENSURE