Provider Demographics
NPI:1598339483
Name:LOZANO, KANDICE TRISHA (LICSW)
Entity Type:Individual
Prefix:
First Name:KANDICE
Middle Name:TRISHA
Last Name:LOZANO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 MORSE ST APT 2
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-2504
Mailing Address - Country:US
Mailing Address - Phone:818-521-1647
Mailing Address - Fax:
Practice Address - Street 1:10 CAREMATRIX DR
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-6149
Practice Address - Country:US
Practice Address - Phone:617-781-6693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical