Provider Demographics
NPI:1063176360
Name:SOMERS, KANDACE P
Entity type:Individual
Prefix:MS
First Name:KANDACE
Middle Name:P
Last Name:SOMERS
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 1:181 BROOKFIELD DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-3869
Mailing Address - Country:US
Mailing Address - Phone:732-616-9273
Mailing Address - Fax:
Practice Address - Street 1:181 BROOKFIELD DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-3869
Practice Address - Country:US
Practice Address - Phone:732-616-9273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-24
Last Update Date:2021-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-21-49842103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst