Provider Demographics
NPI:1508499708
Name:RYAN, CANDACE J (LCSW)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:J
Last Name:RYAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5581 LOCHCREST CIR
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-8857
Mailing Address - Country:US
Mailing Address - Phone:973-610-7000
Mailing Address - Fax:
Practice Address - Street 1:5581 LOCHCREST CIR
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-8857
Practice Address - Country:US
Practice Address - Phone:973-610-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-16
Last Update Date:2020-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20980001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical