Provider Demographics
NPI:1013737006
Name:TUMMILLO, CANDICE A (MSW, LCSW, OCW-C)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:A
Last Name:TUMMILLO
Suffix:
Gender:F
Credentials:MSW, LCSW, OCW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 E PRATT ST STE 560
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-3558
Mailing Address - Country:US
Mailing Address - Phone:434-401-4075
Mailing Address - Fax:
Practice Address - Street 1:729 E PRATT STREET
Practice Address - Street 2:SUITE 560
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-2120
Practice Address - Country:US
Practice Address - Phone:434-401-4075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-14
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC059052001041C0700X
PACW0208281041C0700X
WALW615076491041C0700X
MD319101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical