Provider Demographics
NPI:1154534105
Name:MARY CANDELARIA
Entity type:Organization
Organization Name:MARY CANDELARIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:F
Authorized Official - Last Name:CANDELARIA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:425-347-7275
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 1:127 E INTERCITY AVE STE A
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-2732
Practice Address - Country:US
Practice Address - Phone:425-347-7275
Practice Address - Fax:425-355-0626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2200103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty