Provider Demographics
NPI:1861497554
Name:CALDARELLA, PAUL (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:CALDARELLA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-2146
Mailing Address - Country:US
Mailing Address - Phone:801-622-5779
Mailing Address - Fax:
Practice Address - Street 1:1117 COUNTRY HILLS DR
Practice Address - Street 2:STE 8
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-2467
Practice Address - Country:US
Practice Address - Phone:801-475-0402
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3789262501103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist