Provider Demographics
NPI:1225138233
Name:CALABRESE, REBECCA G (LCSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:G
Last Name:CALABRESE
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 1:51 LAKESIDE BOULEVARD EAST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708
Mailing Address - Country:US
Mailing Address - Phone:203-753-9743
Mailing Address - Fax:203-286-1293
Practice Address - Street 1:51 LAKESIDE BOULEVARD EAST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708
Practice Address - Country:US
Practice Address - Phone:203-753-9743
Practice Address - Fax:203-286-1293
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0027911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT079522OtherMHN
CT140002791CT01OtherANTHEM BCBS OF CT