Provider Demographics
NPI:1558377937
Name:COLANTUONI, JAIME CALISI (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:JAIME
Middle Name:CALISI
Last Name:COLANTUONI
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 PITMAN AVE
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-4249
Mailing Address - Country:US
Mailing Address - Phone:781-727-5965
Mailing Address - Fax:
Practice Address - Street 1:38 MONTVALE AVE
Practice Address - Street 2:SUITE 207, BOX A9
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-2446
Practice Address - Country:US
Practice Address - Phone:781-727-5965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1147471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical