Provider Demographics
NPI:1336544162
Name:CALDERA, MIGUEL (LADC)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:
Last Name:CALDERA
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:WILLIMANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06226-2528
Mailing Address - Country:US
Mailing Address - Phone:860-450-0151
Mailing Address - Fax:860-450-7152
Practice Address - Street 1:54 NORTH ST
Practice Address - Street 2:
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226-2528
Practice Address - Country:US
Practice Address - Phone:860-450-0151
Practice Address - Fax:860-450-7152
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT585101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)