Provider Demographics
NPI:1588862148
Name:LIMMER, CANDICE M (MS)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:M
Last Name:LIMMER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:M
Other - Last Name:LIMMER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:PO BOX 904
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:CT
Mailing Address - Zip Code:06019-0904
Mailing Address - Country:US
Mailing Address - Phone:860-693-6344
Mailing Address - Fax:860-693-1160
Practice Address - Street 1:259 ALBANY TPKE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:CT
Practice Address - Zip Code:06019-2557
Practice Address - Country:US
Practice Address - Phone:860-693-6344
Practice Address - Fax:860-693-1160
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001881101YP2500X
AK566101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional