Provider Demographics
NPI:1588455802
Name:MORREN, CANDY DENESIA
Entity type:Individual
Prefix:
First Name:CANDY
Middle Name:DENESIA
Last Name:MORREN
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14235 84TH DR APT 5L
Mailing Address - Street 2:
Mailing Address - City:BRIARWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11435-2251
Mailing Address - Country:US
Mailing Address - Phone:347-458-2015
Mailing Address - Fax:
Practice Address - Street 1:19544 WOODHULL AVE
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-2982
Practice Address - Country:US
Practice Address - Phone:347-458-2015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008660-01224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant