Provider Demographics
NPI:1598973968
Name:CALVANO, PAMELA (L M F T)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:
Last Name:CALVANO
Suffix:
Gender:F
Credentials:L M F T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2288 YANKEE ST
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-3903
Mailing Address - Country:US
Mailing Address - Phone:574-287-1879
Mailing Address - Fax:574-234-6025
Practice Address - Street 1:818 E JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-2905
Practice Address - Country:US
Practice Address - Phone:574-287-1879
Practice Address - Fax:574-234-6025
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35000777A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist