Provider Demographics
NPI:1639853286
Name:CALDERON, SEBASTIAN DAVID (MSW)
Entity Type:Individual
Prefix:MR
First Name:SEBASTIAN
Middle Name:DAVID
Last Name:CALDERON
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 W 176 LN S
Mailing Address - Street 2:
Mailing Address - City:PAUL
Mailing Address - State:ID
Mailing Address - Zip Code:83347-8697
Mailing Address - Country:US
Mailing Address - Phone:208-650-5822
Mailing Address - Fax:
Practice Address - Street 1:1360 ALBION AVE
Practice Address - Street 2:
Practice Address - City:BURLEY
Practice Address - State:ID
Practice Address - Zip Code:83318-1818
Practice Address - Country:US
Practice Address - Phone:208-878-7008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor