Provider Demographics
NPI:1811050685
Name:CALTA, MARYANN (LCSW,CMSW LMHP, MDIV)
Entity type:Individual
Prefix:
First Name:MARYANN
Middle Name:
Last Name:CALTA
Suffix:
Gender:F
Credentials:LCSW,CMSW LMHP, MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 FARNAM ST
Mailing Address - Street 2:SUITE 215
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68102-2200
Mailing Address - Country:US
Mailing Address - Phone:402-393-0642
Mailing Address - Fax:402-391-2641
Practice Address - Street 1:1403 FARNAM ST
Practice Address - Street 2:SUITE 215
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68102-2200
Practice Address - Country:US
Practice Address - Phone:402-393-0642
Practice Address - Fax:402-391-2641
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1505101YM0800X, 101YP2500X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical