Provider Demographics
NPI:1437446739
Name:DECANDIA, CARMELA JOSEPHINE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CARMELA
Middle Name:JOSEPHINE
Last Name:DECANDIA
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 1:24R SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-1518
Mailing Address - Country:US
Mailing Address - Phone:617-916-0156
Mailing Address - Fax:
Practice Address - Street 1:24R SCHOOL ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02458-1518
Practice Address - Country:US
Practice Address - Phone:617-916-0156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-07
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7805103TC0700X, 103TC2200X
NY017789103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical