Provider Demographics
NPI:1750709937
Name:BOLBACH, CANDICE (LMSW)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:
Last Name:BOLBACH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W 58TH ST APT 12A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1477
Mailing Address - Country:US
Mailing Address - Phone:914-672-6841
Mailing Address - Fax:
Practice Address - Street 1:200 W 58TH ST APT 12A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1477
Practice Address - Country:US
Practice Address - Phone:914-672-6841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-03
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY064758-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical