Provider Demographics
NPI:1922178300
Name:FOSTER, CANDACE F (LICSW)
Entity Type:Individual
Prefix:MS
First Name:CANDACE
Middle Name:F
Last Name:FOSTER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 LINCOLN RD
Mailing Address - Street 2:BOX 436
Mailing Address - City:LINCOLN
Mailing Address - State:MA
Mailing Address - Zip Code:01773-3840
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:145 LINCOLN RD
Practice Address - Street 2:BOX 436
Practice Address - City:LINCOLN
Practice Address - State:MA
Practice Address - Zip Code:01773-3840
Practice Address - Country:US
Practice Address - Phone:781-259-8501
Practice Address - Fax:781-259-8501
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0000901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP01266Medicare ID - Type Unspecified
MA000090Medicare UPIN