Provider Demographics
NPI:1821007907
Name:CALDWELL, JUNE M (MA)
Entity Type:Individual
Prefix:MRS
First Name:JUNE
Middle Name:M
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 THE STRAND
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-4559
Mailing Address - Country:US
Mailing Address - Phone:319-545-6392
Mailing Address - Fax:310-546-1862
Practice Address - Street 1:1840 S ELENA AVE
Practice Address - Street 2:STE. 205
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-5703
Practice Address - Country:US
Practice Address - Phone:310-375-0442
Practice Address - Fax:310-546-1862
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAM12987106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist