Provider Demographics
NPI:1609681162
Name:CEDAR PSYCHOLOGY SERVICES, LLC
Entity type:Organization
Organization Name:CEDAR PSYCHOLOGY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CANDYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:TART
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:505-805-2912
Mailing Address - Street 1:4810 HARDWARE DR NE STE 4
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-2013
Mailing Address - Country:US
Mailing Address - Phone:505-805-2912
Mailing Address - Fax:
Practice Address - Street 1:4810 HARDWARE DR NE STE 4
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2013
Practice Address - Country:US
Practice Address - Phone:505-805-2912
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-11
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty