Provider Demographics
NPI:1184972317
Name:SIEGMUND, CANDACE SUZANNE (PSYD)
Entity type:Individual
Prefix:DR
First Name:CANDACE
Middle Name:SUZANNE
Last Name:SIEGMUND
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:CANDACE
Other - Middle Name:SUZANNE
Other - Last Name:BURNHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:12304 SANTA MONICA BLVD STE 379
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1542
Mailing Address - Country:US
Mailing Address - Phone:213-223-8402
Mailing Address - Fax:
Practice Address - Street 1:12304 SANTA MONICA BLVD STE 379
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1542
Practice Address - Country:US
Practice Address - Phone:213-223-8402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-20
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29454103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist