Provider Demographics
NPI:1457818114
Name:GAETA, CANDACE CAMILLE
Entity Type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:CAMILLE
Last Name:GAETA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 HALE STREET
Mailing Address - Street 2:LANDMARK HIGH SCHOOL
Mailing Address - City:PRIDES CROSSING
Mailing Address - State:MA
Mailing Address - Zip Code:01965
Mailing Address - Country:US
Mailing Address - Phone:978-810-1440
Mailing Address - Fax:
Practice Address - Street 1:412 HALE STREET
Practice Address - Street 2:LANDMARK HIGH SCHOOL
Practice Address - City:PRIDES CROSSING
Practice Address - State:MA
Practice Address - Zip Code:01965
Practice Address - Country:US
Practice Address - Phone:978-810-1440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-28
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2197241041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool