Provider Demographics
NPI:1104000611
Name:CALDERON, BLANCA ALICIA (MLHC)
Entity Type:Individual
Prefix:
First Name:BLANCA
Middle Name:ALICIA
Last Name:CALDERON
Suffix:
Gender:F
Credentials:MLHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 QUEEN ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01610-2473
Mailing Address - Country:US
Mailing Address - Phone:508-860-7975
Mailing Address - Fax:508-860-7990
Practice Address - Street 1:48 CEDAR ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-2134
Practice Address - Country:US
Practice Address - Phone:508-615-7232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-19
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5796101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1300709Medicaid
MA18618OtherCMHC-BCBSMA