Provider Demographics
NPI:1487789962
Name:CANDELARIA, LAURA K (LICSW)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:K
Last Name:CANDELARIA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 LORNA DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01501-1242
Mailing Address - Country:US
Mailing Address - Phone:508-450-1090
Mailing Address - Fax:
Practice Address - Street 1:45 OAK ST
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-2733
Practice Address - Country:US
Practice Address - Phone:508-841-1240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA213851104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1301071Medicaid