Provider Demographics
NPI:1083148431
Name:NINA M. KALCKAR, LCSW
Entity Type:Organization
Organization Name:NINA M. KALCKAR, LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:KALCKAR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:617-899-4923
Mailing Address - Street 1:PO BOX 1496
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-1496
Mailing Address - Country:US
Mailing Address - Phone:617-899-4923
Mailing Address - Fax:
Practice Address - Street 1:65-1206 MAMALAHOA HWY
Practice Address - Street 2:BLD 2-2
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-7303
Practice Address - Country:US
Practice Address - Phone:808-333-2567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI4034251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health