Provider Demographics
NPI:1851642532
Name:CANDELARIO, CARMEN (MA)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:CANDELARIO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 CALLE MIMOSA
Mailing Address - Street 2:URB. EL ROCIO
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736-4881
Mailing Address - Country:US
Mailing Address - Phone:787-597-8707
Mailing Address - Fax:
Practice Address - Street 1:350 AVE FONT MARTELO
Practice Address - Street 2:OFICINA 202
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-3266
Practice Address - Country:US
Practice Address - Phone:787-597-8707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-21
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2528103TS0200X
PR6092355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant