Provider Demographics
NPI:1396379640
Name:CALDERON, JASIR (BA)
Entity Type:Individual
Prefix:
First Name:JASIR
Middle Name:
Last Name:CALDERON
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:JASIR
Other - Middle Name:
Other - Last Name:CALDERON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:12 DIAMOND ST APT 17
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-2049
Mailing Address - Country:US
Mailing Address - Phone:978-652-8046
Mailing Address - Fax:
Practice Address - Street 1:10 GILL ST STE J
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-1721
Practice Address - Country:US
Practice Address - Phone:617-505-6183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician