Provider Demographics
NPI:1073139275
Name:SILVEIRA-CARPENTER, CANDICE (PHD)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:
Last Name:SILVEIRA-CARPENTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:
Other - Last Name:SILVEIRA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:406 9TH AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-7277
Mailing Address - Country:US
Mailing Address - Phone:619-800-6060
Mailing Address - Fax:619-780-7961
Practice Address - Street 1:406 9TH AVE STE 208
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-7277
Practice Address - Country:US
Practice Address - Phone:619-800-6060
Practice Address - Fax:619-780-7961
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-23
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35516103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical