Provider Demographics
NPI:1265434914
Name:CALDWELL, JOEL N (CP)
Entity type:Individual
Prefix:MR
First Name:JOEL
Middle Name:N
Last Name:CALDWELL
Suffix:
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 PAYNE ST
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NY
Mailing Address - Zip Code:13346-1111
Mailing Address - Country:US
Mailing Address - Phone:315-825-0180
Mailing Address - Fax:
Practice Address - Street 1:4567 CROSSROADS PARK DR
Practice Address - Street 2:2ND FLOOR
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-3589
Practice Address - Country:US
Practice Address - Phone:315-295-2100
Practice Address - Fax:315-295-2126
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014006103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02190590Medicaid
NY02190590Medicaid
NYRA6969Medicare PIN