Provider Demographics
NPI:1184051914
Name:BRADIGAN, CANDACE
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:BRADIGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2500
Mailing Address - Street 2:FCI ALLENWOOD MEDIUM, FEDERAL CORRECTIONAL INSTITUTION
Mailing Address - City:WHITE DEER
Mailing Address - State:PA
Mailing Address - Zip Code:17887
Mailing Address - Country:US
Mailing Address - Phone:570-547-7950
Mailing Address - Fax:
Practice Address - Street 1:FCI ALLENWOOD MEDIUM
Practice Address - Street 2:ROUTE 15
Practice Address - City:WHITE DEER
Practice Address - State:PA
Practice Address - Zip Code:17887
Practice Address - Country:US
Practice Address - Phone:570-547-7950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-11
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW129172104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker