Provider Demographics
NPI:1265201388
Name:ROBINSON, CANDICE A
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:A
Last Name:ROBINSON
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 1:108 COOPERTOWNE BLVD
Mailing Address - Street 2:
Mailing Address - City:SOMERDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:08083-1462
Mailing Address - Country:US
Mailing Address - Phone:856-308-2279
Mailing Address - Fax:
Practice Address - Street 1:108 COOPERTOWNE BLVD
Practice Address - Street 2:
Practice Address - City:SOMERDALE
Practice Address - State:NJ
Practice Address - Zip Code:08083-1462
Practice Address - Country:US
Practice Address - Phone:856-308-2279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-29
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker