Provider Demographics
NPI:1528028685
Name:CALVERT, SHARON JANE (PHD)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:JANE
Last Name:CALVERT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 723
Mailing Address - Street 2:496 N. THIRD AVE.
Mailing Address - City:PATAGONIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85624-0723
Mailing Address - Country:US
Mailing Address - Phone:520-394-0048
Mailing Address - Fax:
Practice Address - Street 1:2240 E WINROW AVE
Practice Address - Street 2:USA MEDDAC, RWBAHC ATTN: MCXJ-CREDENTIALS
Practice Address - City:FORT HUACHUCA
Practice Address - State:AZ
Practice Address - Zip Code:85613-7079
Practice Address - Country:US
Practice Address - Phone:520-533-1696
Practice Address - Fax:520-533-7099
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1147103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ714198Medicaid
AZVAD0000Medicare UPIN
AZ714198Medicaid