Provider Demographics
NPI:1154836906
Name:CALDERON, MARTHA G (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:G
Last Name:CALDERON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1907 CUMBERLAND DR
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91792-1521
Mailing Address - Country:US
Mailing Address - Phone:626-476-3587
Mailing Address - Fax:
Practice Address - Street 1:599 S BARRANCA AVE STE 208
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-2785
Practice Address - Country:US
Practice Address - Phone:626-476-3587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-01
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA294881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty