Provider Demographics
NPI:1366895450
Name:MADRIGAL, CANDIDA R (LCSW)
Entity type:Individual
Prefix:DR
First Name:CANDIDA
Middle Name:R
Last Name:MADRIGAL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:283 BUTLER RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT GRETNA
Mailing Address - State:PA
Mailing Address - Zip Code:17064-6085
Mailing Address - Country:US
Mailing Address - Phone:717-273-8871
Mailing Address - Fax:717-279-2792
Practice Address - Street 1:283 BUTLER RD
Practice Address - Street 2:
Practice Address - City:MOUNT GRETNA
Practice Address - State:PA
Practice Address - Zip Code:17064-6085
Practice Address - Country:US
Practice Address - Phone:717-273-8871
Practice Address - Fax:717-273-2732
Is Sole Proprietor?:No
Enumeration Date:2016-07-13
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0190641041C0700X
CALCS228621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical