Provider Demographics
NPI:1902207111
Name:CANDREVA, ILENE ALLINGER (MSW BCBA)
Entity Type:Individual
Prefix:
First Name:ILENE
Middle Name:ALLINGER
Last Name:CANDREVA
Suffix:
Gender:F
Credentials:MSW BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 GARDEN RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-5373
Mailing Address - Country:US
Mailing Address - Phone:831-372-2730
Mailing Address - Fax:
Practice Address - Street 1:1900 GARDEN RD
Practice Address - Street 2:SUITE 230
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-5373
Practice Address - Country:US
Practice Address - Phone:831-372-2730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-07
Last Update Date:2014-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA#1-14-15147103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst