Provider Demographics
NPI:1033896964
Name:CALDWELL, MAGEN
Entity Type:Individual
Prefix:
First Name:MAGEN
Middle Name:
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 S ROOSEVELT RD APT F9
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-1752
Mailing Address - Country:US
Mailing Address - Phone:480-334-0213
Mailing Address - Fax:
Practice Address - Street 1:505 S ROOSEVELT RD APT F9
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-1752
Practice Address - Country:US
Practice Address - Phone:480-334-0213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician