Provider Demographics
NPI:1386321958
Name:TOLENTINO, CANDACE SUE (BT)
Entity type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:SUE
Last Name:TOLENTINO
Suffix:
Gender:F
Credentials:BT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 E CONESTOGA SERVICE
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17557
Mailing Address - Country:US
Mailing Address - Phone:717-418-4216
Mailing Address - Fax:
Practice Address - Street 1:350 E CONESTOGA SERVICE
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:PA
Practice Address - Zip Code:17557
Practice Address - Country:US
Practice Address - Phone:717-418-4216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician