Provider Demographics
NPI:1477210623
Name:SPARKMAN, CANDICE W (LMSW)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:W
Last Name:SPARKMAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:W
Other - Last Name:CRAWFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:845 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10603-2403
Mailing Address - Country:US
Mailing Address - Phone:914-761-0600
Mailing Address - Fax:
Practice Address - Street 1:845 N BROADWAY
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10603-2403
Practice Address - Country:US
Practice Address - Phone:914-761-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-23
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY114592-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker