Provider Demographics
NPI:1487033122
Name:CALDWELL, NICOLE (MSW, ASW, CATC-IV)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:MSW, ASW, CATC-IV
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:ARAGON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, ASW, CATC-IV
Mailing Address - Street 1:831 E ARROW HWY
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-2535
Mailing Address - Country:US
Mailing Address - Phone:909-398-4383
Mailing Address - Fax:909-445-8936
Practice Address - Street 1:8350 ARCHIBALD AVE
Practice Address - Street 2:205
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3669
Practice Address - Country:US
Practice Address - Phone:909-274-8928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-27
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X, 104100000X
CA652971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker