Provider Demographics
NPI:1629242904
Name:ROMBOUSEK, CANDACE (LCSW)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:ROMBOUSEK
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 1:396 RT. 6 & 209 STE. 3B
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18337-9490
Mailing Address - Country:US
Mailing Address - Phone:570-296-1742
Mailing Address - Fax:570-296-4044
Practice Address - Street 1:396 ROUTE 6 AND 209 STE 3B
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18337-9411
Practice Address - Country:US
Practice Address - Phone:570-296-1742
Practice Address - Fax:570-296-4044
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW006796-L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical