Provider Demographics
NPI:1538517107
Name:CANDELARIO, ELSA
Entity Type:Individual
Prefix:
First Name:ELSA
Middle Name:
Last Name:CANDELARIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 W ROUTE 38
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-3238
Mailing Address - Country:US
Mailing Address - Phone:856-409-0400
Mailing Address - Fax:
Practice Address - Street 1:212 W ROUTE 38
Practice Address - Street 2:SUITE 200
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3238
Practice Address - Country:US
Practice Address - Phone:856-409-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05163900104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker