Provider Demographics
NPI:1851922611
Name:CALDERON, ROBERTO ANTONIO (LCSW)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:ANTONIO
Last Name:CALDERON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 881033
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92168-1033
Mailing Address - Country:US
Mailing Address - Phone:858-751-4643
Mailing Address - Fax:
Practice Address - Street 1:2535 CAMINO DEL RIO S STE 230
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3795
Practice Address - Country:US
Practice Address - Phone:858-751-4643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA746351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical