Provider Demographics
NPI:1790293439
Name:CALVIN, MARY ROGENIA (PLPC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ROGENIA
Last Name:CALVIN
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 SAINT MARYS AVE
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-3727
Mailing Address - Country:US
Mailing Address - Phone:573-221-2273
Mailing Address - Fax:573-221-1720
Practice Address - Street 1:2910 SAINT MARYS AVE
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-3727
Practice Address - Country:US
Practice Address - Phone:573-221-2273
Practice Address - Fax:573-221-1720
Is Sole Proprietor?:No
Enumeration Date:2018-01-16
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017044750101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional