Provider Demographics
NPI:1063938777
Name:CALKINS, OLIVIA MOORE
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:MOORE
Last Name:CALKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 90TH ST
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-1879
Mailing Address - Country:US
Mailing Address - Phone:650-877-5700
Mailing Address - Fax:
Practice Address - Street 1:350 90TH ST FL 3
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-1879
Practice Address - Country:US
Practice Address - Phone:831-595-1796
Practice Address - Fax:650-877-5701
Is Sole Proprietor?:No
Enumeration Date:2017-08-15
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW95392101Y00000X, 1041C0700X
CA1166351041C0700X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical