Provider Demographics
NPI:1174827950
Name:MCCALDEN, CARIANNE TAYLOR (MA)
Entity Type:Individual
Prefix:
First Name:CARIANNE
Middle Name:TAYLOR
Last Name:MCCALDEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1173 CAMBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-1935
Mailing Address - Country:US
Mailing Address - Phone:773-732-9187
Mailing Address - Fax:
Practice Address - Street 1:1173 CAMBRIDGE RD
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-1935
Practice Address - Country:US
Practice Address - Phone:773-732-9187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014042103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical