Provider Demographics
NPI:1013167311
Name:CALDWELL, ELIJAH (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ELIJAH
Middle Name:
Last Name:CALDWELL
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 1:60 N MAIN ST
Mailing Address - Street 2:3RD FLR.
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06702-1443
Mailing Address - Country:US
Mailing Address - Phone:203-437-8896
Mailing Address - Fax:
Practice Address - Street 1:60 N MAIN ST
Practice Address - Street 2:3RD FLR
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06702-1443
Practice Address - Country:US
Practice Address - Phone:203-437-8896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-23
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5149363LF0000X
CT0082011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008042640Medicaid
CT004040655Medicaid