Provider Demographics
NPI:1417702127
Name:LASTER, CANDACE JANAE (LMSW)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:JANAE
Last Name:LASTER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 QUEENS ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3724
Mailing Address - Country:US
Mailing Address - Phone:631-923-5438
Mailing Address - Fax:
Practice Address - Street 1:640 EAGLE ROCK AVE STE 1
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-2931
Practice Address - Country:US
Practice Address - Phone:862-930-3925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL070820001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical