Provider Demographics
NPI:1891864302
Name:CALVIN, RICHMOND EDWARD (LCSW LMFT LHMC)
Entity Type:Individual
Prefix:MR
First Name:RICHMOND
Middle Name:EDWARD
Last Name:CALVIN
Suffix:
Gender:M
Credentials:LCSW LMFT LHMC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 W LEXINGTON
Mailing Address - Street 2:SUITE 206
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46516
Mailing Address - Country:US
Mailing Address - Phone:574-293-5991
Mailing Address - Fax:574-293-5429
Practice Address - Street 1:108 N MAIN ST
Practice Address - Street 2:SUITE 500
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601
Practice Address - Country:US
Practice Address - Phone:574-246-1244
Practice Address - Fax:574-246-1250
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000585A101Y00000X
IN34002613A104100000X
IN35000685A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN179650GMedicare ID - Type Unspecified