Provider Demographics
NPI:1063689784
Name:CALDERONE, KIMBERLEE DAWN SR
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLEE
Middle Name:DAWN
Last Name:CALDERONE
Suffix:SR
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 1:146 RAINIER AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94589-1846
Mailing Address - Country:US
Mailing Address - Phone:707-553-5621
Mailing Address - Fax:707-553-5719
Practice Address - Street 1:146 RAINIER AVE
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-1846
Practice Address - Country:US
Practice Address - Phone:707-553-5621
Practice Address - Fax:707-553-5719
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health