Provider Demographics
NPI:1790885846
Name:CANDIDO, PAUL LOUIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:LOUIS
Last Name:CANDIDO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 PINE HAVEN SHORES RD
Mailing Address - Street 2:SUITE 2032
Mailing Address - City:SHELBURNE
Mailing Address - State:VT
Mailing Address - Zip Code:05482-7703
Mailing Address - Country:US
Mailing Address - Phone:802-864-4513
Mailing Address - Fax:802-985-5061
Practice Address - Street 1:145 PINE HAVEN SHORES RD
Practice Address - Street 2:SUITE 2032
Practice Address - City:SHELBURNE
Practice Address - State:VT
Practice Address - Zip Code:05482-7703
Practice Address - Country:US
Practice Address - Phone:802-864-4513
Practice Address - Fax:802-985-5061
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0480000412103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1002636Medicaid
VT1002636Medicaid