Provider Demographics
NPI:1467449694
Name:CANDIDO, TERESA SMITH (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:SMITH
Last Name:CANDIDO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:TERESA
Other - Middle Name:SMITH
Other - Last Name:CANDIDO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:GSW
Mailing Address - Street 1:67 ETNA RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-1455
Mailing Address - Country:US
Mailing Address - Phone:603-448-0055
Mailing Address - Fax:603-727-9042
Practice Address - Street 1:67 ETNA RD
Practice Address - Street 2:SUITE 350
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-1455
Practice Address - Country:US
Practice Address - Phone:603-448-0055
Practice Address - Fax:603-727-9042
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHNH 14441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN80633Medicare ID - Type Unspecified
NY7400553OtherVALUE OPTIONS/GHI