Active NPI
Kent Candelora, PH.D
- Clinical Psychologist
- Glendale, CA
National Provider Identifier
1770632317
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY5341
- Practice address
- 1530 E Chevy Chase Dr
Suite 103
Glendale, CA 91206-4139 - Phone
- (818) 790-0150
- Fax
- (818) 243-7518
- NPI assigned
- Jan 10, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY5341 | CA | Primary |
Addresses
Primary practice location
1530 E Chevy Chase Dr
Suite 103
Glendale, CA 91206-4139
Mailing address
1530 E Chevy Chase Dr
Suite 103
Glendale, CA 91206-4139
Phone (818) 790-0150
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5341 | CA | MD | Mental Health Counselor |
| PSY5341 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168387200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1325203200000",
"number": "1770632317",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1530 E CHEVY CHASE DR",
"address_2": "SUITE 103",
"city": "GLENDALE",
"state": "CA",
"postal_code": "912064139",
"telephone_number": "818-790-0150",
"fax_number": "818-243-7518"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1530 E CHEVY CHASE DR",
"address_2": "SUITE 103",
"city": "GLENDALE",
"state": "CA",
"postal_code": "912064139",
"telephone_number": "818-790-0150",
"fax_number": "818-243-7518"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CANDELORA",
"first_name": "KENT",
"name_prefix": "Dr.",
"credential": "PH.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-10",
"last_updated": "2011-12-30",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY5341",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glendale, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.