Provider Demographics
NPI:1750559126
Name:MCCALMON, KEISHANNA AMANDA (MS)
Entity type:Individual
Prefix:MS
First Name:KEISHANNA
Middle Name:AMANDA
Last Name:MCCALMON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1532 MAIN ST
Mailing Address - Street 2:2ND FLOOR NORTH
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-1622
Mailing Address - Country:US
Mailing Address - Phone:203-887-0312
Mailing Address - Fax:
Practice Address - Street 1:91 NORTHWEST DR
Practice Address - Street 2:SUITE 204
Practice Address - City:PLAINVILLE
Practice Address - State:CT
Practice Address - Zip Code:06062-1534
Practice Address - Country:US
Practice Address - Phone:860-793-7243
Practice Address - Fax:860-793-4497
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator