Provider Demographics
NPI:1699244970
Name:ESCORZA, CANDY H
Entity type:Individual
Prefix:
First Name:CANDY
Middle Name:H
Last Name:ESCORZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CANDELARIA
Other - Middle Name:H
Other - Last Name:ESCORZA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:504 S LAGUNA AVE
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:AZ
Mailing Address - Zip Code:85344-4440
Mailing Address - Country:US
Mailing Address - Phone:928-669-1999
Mailing Address - Fax:
Practice Address - Street 1:504 S LAGUNA AVE
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:AZ
Practice Address - Zip Code:85344-4440
Practice Address - Country:US
Practice Address - Phone:928-669-1999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-16
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-16217104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker