Provider Demographics
NPI:1851926737
Name:CANDELARIO, LILLIAN M (MED,CP)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:M
Last Name:CANDELARIO
Suffix:
Gender:F
Credentials:MED,CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 LOETSCHER PL APT 106
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-5961
Mailing Address - Country:US
Mailing Address - Phone:787-550-9561
Mailing Address - Fax:
Practice Address - Street 1:24 N 3RD AVE STE 100C
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-2429
Practice Address - Country:US
Practice Address - Phone:609-941-4978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist