Provider Demographics
NPI:1518029255
Name:COWAN, CANDACE (MSW)
Entity Type:Individual
Prefix:MS
First Name:CANDACE
Middle Name:
Last Name:COWAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18226 VENTURA BLVD
Mailing Address - Street 2:SUITE # 210
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4236
Mailing Address - Country:US
Mailing Address - Phone:818-705-6667
Mailing Address - Fax:818-776-1694
Practice Address - Street 1:18226 VENTURA BLVD
Practice Address - Street 2:SUITE # 210
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-4236
Practice Address - Country:US
Practice Address - Phone:818-705-6667
Practice Address - Fax:818-776-1694
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical