Provider Demographics
NPI:1578758702
Name:DESSER, CANDACE R (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:R
Last Name:DESSER
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 1:3910 CAUGHEY RD STE 200
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-4098
Mailing Address - Country:US
Mailing Address - Phone:814-315-3331
Mailing Address - Fax:
Practice Address - Street 1:3910 CAUGHEY RD STE 200
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-4098
Practice Address - Country:US
Practice Address - Phone:814-315-3331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2024-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW013706L104100000X
PACW0169051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker