Provider Demographics
NPI:1205007903
Name:CALDERA, PATRICKA ANN (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:PATRICKA
Middle Name:ANN
Last Name:CALDERA
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:PATTY
Other - Middle Name:A
Other - Last Name:CALDERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LCSW, PHD
Mailing Address - Street 1:20 PORTWEST CT
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-5985
Mailing Address - Country:US
Mailing Address - Phone:636-352-3650
Mailing Address - Fax:877-433-3107
Practice Address - Street 1:20 PORTWEST CT
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-5985
Practice Address - Country:US
Practice Address - Phone:636-352-3650
Practice Address - Fax:877-433-3107
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-20
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.011430104100000X
MO20100105371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL999018OtherHEALTHLINK
IL000000631722OtherBCBSIL