Provider Demographics
NPI:1780018309
Name:CALVERT, MARISA (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:CALVERT
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 NW SPRUCE AVE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-1212
Mailing Address - Country:US
Mailing Address - Phone:541-733-5805
Mailing Address - Fax:
Practice Address - Street 1:1009 NW SPRUCE AVE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-1212
Practice Address - Country:US
Practice Address - Phone:541-733-5805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-30
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL107661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical