Provider Demographics
NPI:1134331697
Name:GESNER, CANDACE J (MA, LMFT)
Entity type:Individual
Prefix:MS
First Name:CANDACE
Middle Name:J
Last Name:GESNER
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:MS
Other - First Name:CANDACE
Other - Middle Name:J
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:4470 W SUNSET BLVD
Mailing Address - Street 2:BOX 280
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6302
Mailing Address - Country:US
Mailing Address - Phone:323-229-9517
Mailing Address - Fax:323-660-2342
Practice Address - Street 1:4470 W SUNSET BLVD
Practice Address - Street 2:BOX 280
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6302
Practice Address - Country:US
Practice Address - Phone:323-229-9517
Practice Address - Fax:323-660-2342
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 45290106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist