Provider Demographics
NPI:1306983861
Name:CHANG, CANDACE (MSW)
Entity type:Individual
Prefix:MS
First Name:CANDACE
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 WACHUSETT ST # 2
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-4138
Mailing Address - Country:US
Mailing Address - Phone:617-371-3010
Mailing Address - Fax:617-371-3044
Practice Address - Street 1:105 VICTORY RD.
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122
Practice Address - Country:US
Practice Address - Phone:617-371-3010
Practice Address - Fax:617-371-3044
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1065141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical