Provider Demographics
NPI:1942389671
Name:D'ANTONIO, CANDACE LYN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:LYN
Last Name:D'ANTONIO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 BIDDLE AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-3968
Mailing Address - Country:US
Mailing Address - Phone:302-261-6526
Mailing Address - Fax:302-365-6486
Practice Address - Street 1:200 BIDDLE AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-3968
Practice Address - Country:US
Practice Address - Phone:302-261-6526
Practice Address - Fax:302-365-6486
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-00010441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
517251OtherUHC MAMSI GROUP
DCR968OtherCAREFIRST FEDERAL GROUP