Provider Demographics
NPI:1528212057
Name:CORRAO, CANDICE LYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:LYNN
Last Name:CORRAO
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 1:31 SAMUEL RODMAN ST
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-2105
Mailing Address - Country:US
Mailing Address - Phone:140-136-9013
Mailing Address - Fax:
Practice Address - Street 1:1145 RESERVOIR AVE STE 302
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-6000
Practice Address - Country:US
Practice Address - Phone:401-369-0233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-11
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW020481041C0700X
RICSW011411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical