Provider Demographics
NPI:1952558157
Name:CALDERON, NELSON LEONEL JR (LCSW)
Entity Type:Individual
Prefix:
First Name:NELSON
Middle Name:LEONEL
Last Name:CALDERON
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2640 INDUSTRY WAY STE B
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-4285
Mailing Address - Country:US
Mailing Address - Phone:310-627-4525
Mailing Address - Fax:
Practice Address - Street 1:2640 INDUSTRY WAY STE B
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-4285
Practice Address - Country:US
Practice Address - Phone:310-627-4525
Practice Address - Fax:310-627-4531
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA811221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical