Provider Demographics
NPI:1134278732
Name:CALDER, JENNIFER (LICSW)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:CALDER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 MAIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05602-4258
Mailing Address - Country:US
Mailing Address - Phone:802-223-7364
Mailing Address - Fax:
Practice Address - Street 1:250 MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-4258
Practice Address - Country:US
Practice Address - Phone:802-223-7364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089-00011091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT69558OtherBLUE CROSS BLUE SHIELD
VT03036OtherCBA
VT1013024Medicaid
VT69558OtherMAGELLAN BEHAVIORAL HEALT
VT4151125OtherMVP