Provider Demographics
NPI:1669055430
Name:CALVERT, JUDITH (RBT)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:CALVERT
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:
Other - Last Name:CALVERT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BCBA, APRN
Mailing Address - Street 1:2360 CORAL WAY APT 8
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33145-3529
Mailing Address - Country:US
Mailing Address - Phone:786-575-7022
Mailing Address - Fax:
Practice Address - Street 1:13195 SW 134TH ST STE 101-103
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4499
Practice Address - Country:US
Practice Address - Phone:786-227-6830
Practice Address - Fax:786-524-2413
Is Sole Proprietor?:No
Enumeration Date:2021-04-29
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11022947363L00000X, 363LA2200X, 363LG0600X
FL1-24-77022103K00000X
FLRN9540325163W00000X
FLRBT-21-152014106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL120371800Medicaid