Individual
CANDACE LORRAINE SAMUEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
B.S.W.
Contact information
Practice address
1210 NW 166TH AVE, PEMBROKE PINES, FL 33028-1342
(954) 443-0904
Mailing address
1210 NW 166TH AVE, PEMBROKE PINES, FL 33028-1342
(954) 443-0904
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002528500
TCM MEDICAID
FL
Enumeration date
05/18/2010
Last updated
11/12/2010
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