Provider Demographics
NPI:1982854998
Name:KANDILAKIS, DIANA ELAINE (LCPC)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:ELAINE
Last Name:KANDILAKIS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MS
Other - First Name:DIANA
Other - Middle Name:ELAINE
Other - Last Name:DELZOPPO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:23 JEWETT AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BERWICK
Mailing Address - State:ME
Mailing Address - Zip Code:03908-1109
Mailing Address - Country:US
Mailing Address - Phone:603-312-1820
Mailing Address - Fax:207-985-1281
Practice Address - Street 1:23 JEWETT AVE
Practice Address - Street 2:
Practice Address - City:SOUTH BERWICK
Practice Address - State:ME
Practice Address - Zip Code:03908-1109
Practice Address - Country:US
Practice Address - Phone:603-312-1820
Practice Address - Fax:207-985-1281
Is Sole Proprietor?:No
Enumeration Date:2008-09-26
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC1529101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health