Provider Demographics
NPI:1669930277
Name:CALVIMONTE, JAMES
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:CALVIMONTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:554 W CENTER ST
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-4428
Mailing Address - Country:US
Mailing Address - Phone:435-764-2479
Mailing Address - Fax:
Practice Address - Street 1:150 E 200 N STE O
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-4036
Practice Address - Country:US
Practice Address - Phone:435-799-5035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9121936-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty