Provider Demographics
NPI:1629586235
Name:CANDELARIO, JURY III (LCSW)
Entity Type:Individual
Prefix:
First Name:JURY
Middle Name:
Last Name:CANDELARIO
Suffix:III
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3055 WILSHIRE BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-1147
Mailing Address - Country:US
Mailing Address - Phone:213-553-1832
Mailing Address - Fax:213-553-1833
Practice Address - Street 1:3055 WILSHIRE BLVD STE 300
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-1147
Practice Address - Country:US
Practice Address - Phone:213-553-1832
Practice Address - Fax:213-553-1833
Is Sole Proprietor?:No
Enumeration Date:2018-01-17
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87611101YM0800X
390200000X
CA1064421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program