Provider Demographics
NPI:1629146428
Name:CALDERON, RITA L (LCSW)
Entity Type:Individual
Prefix:MS
First Name:RITA
Middle Name:L
Last Name:CALDERON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:570 FORT WASHINGTON AVE
Mailing Address - Street 2:#75B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-2054
Mailing Address - Country:US
Mailing Address - Phone:212-740-9177
Mailing Address - Fax:212-568-6467
Practice Address - Street 1:19 W 34TH ST
Practice Address - Street 2:PH STE.
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3006
Practice Address - Country:US
Practice Address - Phone:646-220-6114
Practice Address - Fax:212-568-6467
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR052870-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNOG761Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID