Provider Demographics
NPI:1467574442
Name:CALDERWOOD, LISA D (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:D
Last Name:CALDERWOOD
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 1:3509 GREENFIELD DR
Mailing Address - Street 2:
Mailing Address - City:AMMON
Mailing Address - State:ID
Mailing Address - Zip Code:83406-7612
Mailing Address - Country:US
Mailing Address - Phone:208-552-9174
Mailing Address - Fax:208-552-9175
Practice Address - Street 1:650 10TH ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-5067
Practice Address - Country:US
Practice Address - Phone:208-552-9174
Practice Address - Fax:208-552-9175
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2023-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-27801101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor