Provider Demographics
NPI:1699865428
Name:KANDEL, CARLA FAY (LCSWR)
Entity type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:FAY
Last Name:KANDEL
Suffix:
Gender:M
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 SHADY RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-1130
Mailing Address - Country:US
Mailing Address - Phone:845-354-6387
Mailing Address - Fax:845-354-6387
Practice Address - Street 1:4 SHADY RIDGE LN
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-1130
Practice Address - Country:US
Practice Address - Phone:845-354-6387
Practice Address - Fax:845-354-6387
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR021076-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY236505OtherMAGELLAN
NY7672237OtherAETNA
NY7672237OtherAETNA