Provider Demographics
NPI:1790303154
Name:DALKIEWICZ, EDWARD CALABRO
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:CALABRO
Last Name:DALKIEWICZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 WILLOWDALE DR APT 31
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-1040
Mailing Address - Country:US
Mailing Address - Phone:301-704-9744
Mailing Address - Fax:
Practice Address - Street 1:120 WILLOWDALE DR APT 31
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-1040
Practice Address - Country:US
Practice Address - Phone:301-704-9744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician