Provider Demographics
NPI:1790941862
Name:MARY CALDERON, LCSW, LLC
Entity Type:Organization
Organization Name:MARY CALDERON, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:CALDERON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:503-675-2830
Mailing Address - Street 1:3990 COLLINS WAY
Mailing Address - Street 2:SUITE #202
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-3480
Mailing Address - Country:US
Mailing Address - Phone:503-675-2830
Mailing Address - Fax:503-675-2852
Practice Address - Street 1:3990 COLLINS WAY
Practice Address - Street 2:SUITE #202
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-3480
Practice Address - Country:US
Practice Address - Phone:503-675-2830
Practice Address - Fax:503-675-2852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-29
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty