Provider Demographics
NPI:1932892676
Name:CALDERON, KRISTEL (LCSW)
Entity Type:Individual
Prefix:
First Name:KRISTEL
Middle Name:
Last Name:CALDERON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 SPRINGFIELD RD
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036-4832
Mailing Address - Country:US
Mailing Address - Phone:732-956-1080
Mailing Address - Fax:
Practice Address - Street 1:9 BASIN DR STE 190
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-6521
Practice Address - Country:US
Practice Address - Phone:973-982-6278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC06224400101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health