Provider Demographics
NPI:1841330859
Name:CANDELARIA, MARY FITCH (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:FITCH
Last Name:CANDELARIA
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 E INTERCITY AVE STE A
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-2732
Mailing Address - Country:US
Mailing Address - Phone:425-347-7275
Mailing Address - Fax:425-355-0626
Practice Address - Street 1:16709 NE 41ST ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-5473
Practice Address - Country:US
Practice Address - Phone:425-702-3447
Practice Address - Fax:425-577-6528
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2025-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2200101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA513308Medicare ID - Type Unspecified