Provider Demographics
NPI:1285874933
Name:CALDERON, MARY (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:CALDERON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:BIRDSALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:19400 NW EVERGREEN PKWY
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-7031
Mailing Address - Country:US
Mailing Address - Phone:503-249-3434
Mailing Address - Fax:971-310-2333
Practice Address - Street 1:19400 NW EVERGREEN PKWY
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-7031
Practice Address - Country:US
Practice Address - Phone:503-249-3434
Practice Address - Fax:971-310-2333
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-20
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL30551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical