Provider Demographics
NPI:1457439838
Name:CHORJEL, CANDACE H (PHD)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:H
Last Name:CHORJEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1570 THE ALAMEDA STE 228
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2305
Mailing Address - Country:US
Mailing Address - Phone:408-294-5585
Mailing Address - Fax:408-294-6147
Practice Address - Street 1:1570 THE ALAMEDA STE 228
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-2305
Practice Address - Country:US
Practice Address - Phone:408-294-5585
Practice Address - Fax:408-294-6147
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 9662103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL96621Medicare ID - Type Unspecified