Provider Demographics
NPI:1740886498
Name:CALZADA, RITA JOAN (PCSW)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:JOAN
Last Name:CALZADA
Suffix:
Gender:F
Credentials:PCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1471 DEWAR DR ST 232
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901
Mailing Address - Country:US
Mailing Address - Phone:307-350-8759
Mailing Address - Fax:
Practice Address - Street 1:1471 DEWAR DR
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-5814
Practice Address - Country:US
Practice Address - Phone:307-350-8759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPCSW-871104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY737CBB8D76Medicaid