Provider Demographics
NPI:1790265346
Name:MISHLER, CANDICE MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:MARIE
Last Name:MISHLER
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 1:1407 EISENHOWER BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-3262
Mailing Address - Country:US
Mailing Address - Phone:814-269-1494
Mailing Address - Fax:814-266-8572
Practice Address - Street 1:1360 EISENHOWER BLVD STE 504
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-3341
Practice Address - Country:US
Practice Address - Phone:814-262-7140
Practice Address - Fax:814-262-7169
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-14
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0207031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty