Provider Demographics
NPI:1184996373
Name:CALVANO, TAMI J
Entity type:Individual
Prefix:MRS
First Name:TAMI
Middle Name:J
Last Name:CALVANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6145 SHAWNEE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-2551
Mailing Address - Country:US
Mailing Address - Phone:702-236-5209
Mailing Address - Fax:
Practice Address - Street 1:580 W CHEYENNE AVE
Practice Address - Street 2:STE 70
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-3967
Practice Address - Country:US
Practice Address - Phone:702-236-5209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV225400000XMedicaid