Provider Demographics
NPI:1821156001
Name:ELLIS, CANDICE CAPRI (LIC AC DIPLOMATE N)
Entity Type:Individual
Prefix:MS
First Name:CANDICE
Middle Name:CAPRI
Last Name:ELLIS
Suffix:
Gender:F
Credentials:LIC AC DIPLOMATE N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:181 ELLIOTT ST
Mailing Address - Street 2:100 CUMMINGS CENTER #321J
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-6123
Mailing Address - Country:US
Mailing Address - Phone:978-969-0252
Mailing Address - Fax:978-969-0356
Practice Address - Street 1:181 ELLIOTT ST
Practice Address - Street 2:100 CUMMINGS CENTER #321J
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6123
Practice Address - Country:US
Practice Address - Phone:978-969-0252
Practice Address - Fax:978-969-0356
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA0163171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist