Provider Demographics
NPI:1861009656
Name:SAVAGE, CANDRA (LSW)
Entity Type:Individual
Prefix:
First Name:CANDRA
Middle Name:
Last Name:SAVAGE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 FIRESIDE CT S
Mailing Address - Street 2:
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-9709
Mailing Address - Country:US
Mailing Address - Phone:423-946-9084
Mailing Address - Fax:
Practice Address - Street 1:258 BROAD ST STE 4
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-2036
Practice Address - Country:US
Practice Address - Phone:423-946-9084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-26
Last Update Date:2020-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06388500104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker