Provider Demographics
NPI:1518437649
Name:CALISTA, JOANNE LYNNE
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:LYNNE
Last Name:CALISTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 FOREST ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-1525
Mailing Address - Country:US
Mailing Address - Phone:508-757-7927
Mailing Address - Fax:
Practice Address - Street 1:35 HARVARD ST STE 300
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-2828
Practice Address - Country:US
Practice Address - Phone:508-756-6676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-02
Last Update Date:2018-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1041C0700X
MA111111111041C0700X
MA10232571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical