Provider Demographics
NPI:1841362787
Name:UNGER, CANDICE PROUDFOOT (RN, LMHC)
Entity type:Individual
Prefix:MRS
First Name:CANDICE
Middle Name:PROUDFOOT
Last Name:UNGER
Suffix:
Gender:F
Credentials:RN, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-1905
Mailing Address - Country:US
Mailing Address - Phone:716-838-1977
Mailing Address - Fax:
Practice Address - Street 1:290 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-1905
Practice Address - Country:US
Practice Address - Phone:716-833-6084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18001293101YM0800X
NY22223666163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered163W00000XNursing Service ProvidersRegistered Nurse