Provider Demographics
NPI:1235939208
Name:SISTERHENM, CANDI LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:CANDI
Middle Name:LYNN
Last Name:SISTERHENM
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 SUMMER ST STE 145A
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-0200
Mailing Address - Country:US
Mailing Address - Phone:978-309-1902
Mailing Address - Fax:978-268-5768
Practice Address - Street 1:76 SUMMER ST STE 145A
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-0200
Practice Address - Country:US
Practice Address - Phone:978-309-1902
Practice Address - Fax:978-268-5768
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALCSW229497104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty