Provider Demographics
NPI:1497240394
Name:MOORE-CALLANDS, MARLENE TRACEY (LMSW)
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:TRACEY
Last Name:MOORE-CALLANDS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 KOHANZA ST
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06811-4406
Mailing Address - Country:US
Mailing Address - Phone:203-470-2819
Mailing Address - Fax:203-778-8308
Practice Address - Street 1:56 DANBURY RD STE 8
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776-3434
Practice Address - Country:US
Practice Address - Phone:203-660-6422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4062104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty