Provider Demographics
NPI:1194821819
Name:RISEN, CANDACE B (LISW)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:B
Last Name:RISEN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23425 COMMERCE PARK
Mailing Address - Street 2:STE 104
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5848
Mailing Address - Country:US
Mailing Address - Phone:216-831-2900
Mailing Address - Fax:216-831-4306
Practice Address - Street 1:23230 CHAGRIN BLVD
Practice Address - Street 2:SUITE 350
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5446
Practice Address - Country:US
Practice Address - Phone:216-831-2900
Practice Address - Fax:216-831-4306
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-00010311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000260213OtherANTHEM BC/BS
OH038397000OtherMAGELLAN
OHS07085Medicare UPIN
OH038397000OtherMAGELLAN