Provider Demographics
NPI:1841382967
Name:CALDWELL, CONSTANCE B (PHD)
Entity Type:Individual
Prefix:DR
First Name:CONSTANCE
Middle Name:B
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:CONSTANCE
Other - Middle Name:BOOTH
Other - Last Name:CALDWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:108 COATSLAND DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-3435
Mailing Address - Country:US
Mailing Address - Phone:731-225-7273
Mailing Address - Fax:
Practice Address - Street 1:108 COATSLAND DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3435
Practice Address - Country:US
Practice Address - Phone:731-225-7273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP0000001773103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3684836Medicaid
TN4052187OtherBCBS # - PARADIGM
TN680015796OtherRR MEDICARE # - PARADIGM
TN3684836Medicaid
TN103I684449Medicare PIN