Provider Demographics
NPI:1457180614
Name:COLLISON, CANDACY (MSED)
Entity type:Individual
Prefix:
First Name:CANDACY
Middle Name:
Last Name:COLLISON
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 SKILLMAN ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-1297
Mailing Address - Country:US
Mailing Address - Phone:718-787-1023
Mailing Address - Fax:929-990-4265
Practice Address - Street 1:250 SKILLMAN ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-1297
Practice Address - Country:US
Practice Address - Phone:718-787-1023
Practice Address - Fax:929-990-4265
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2928381103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool