Provider Demographics
NPI:1366590739
Name:PERRY, CANDACE ANNE (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:ANNE
Last Name:PERRY
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CHEQUESSETT NECK RD
Mailing Address - Street 2:
Mailing Address - City:WELLFLEET
Mailing Address - State:MA
Mailing Address - Zip Code:02667-7314
Mailing Address - Country:US
Mailing Address - Phone:508-349-1922
Mailing Address - Fax:
Practice Address - Street 1:10 CHEQUESSETT NECK RD
Practice Address - Street 2:
Practice Address - City:WELLFLEET
Practice Address - State:MA
Practice Address - Zip Code:02667-7314
Practice Address - Country:US
Practice Address - Phone:508-349-1922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1063181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical