Provider Demographics
NPI:1689305781
Name:CALDERON, VERALLY AZUCENA (LCSW)
Entity Type:Individual
Prefix:
First Name:VERALLY
Middle Name:AZUCENA
Last Name:CALDERON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8150 W BROOKSIDE DR APT 203
Mailing Address - Street 2:
Mailing Address - City:PALOS PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60464-1304
Mailing Address - Country:US
Mailing Address - Phone:773-816-8975
Mailing Address - Fax:
Practice Address - Street 1:8150 W BROOKSIDE DR APT 203
Practice Address - Street 2:
Practice Address - City:PALOS PARK
Practice Address - State:IL
Practice Address - Zip Code:60464-1304
Practice Address - Country:US
Practice Address - Phone:773-816-8975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0222571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical