Provider Demographics
NPI:1902167299
Name:SCHMID, CANDICE CHOW (PHD)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:CHOW
Last Name:SCHMID
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:CANDICE
Other - Middle Name:
Other - Last Name:CHOW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:49 WALTHAM ST STE 2
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-5411
Mailing Address - Country:US
Mailing Address - Phone:617-953-4659
Mailing Address - Fax:
Practice Address - Street 1:49 WALTHAM ST STE 2
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-5411
Practice Address - Country:US
Practice Address - Phone:617-953-4659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-03
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10127103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist