Provider Demographics
NPI:1740372325
Name:CALKINS, CORI J (PSYD)
Entity type:Individual
Prefix:DR
First Name:CORI
Middle Name:J
Last Name:CALKINS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12801 EAGLE POINTE CIR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-7964
Mailing Address - Country:US
Mailing Address - Phone:239-418-1899
Mailing Address - Fax:
Practice Address - Street 1:6150 DIAMOND CENTRE CT UNIT 1003
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-7135
Practice Address - Country:US
Practice Address - Phone:239-561-9955
Practice Address - Fax:239-561-9779
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6814103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL74376OtherBCBS INDIVID. PROVIDER #
FL74976OtherBCBS GROUP PROVIDER #