Provider Demographics
NPI:1366726770
Name:CALDERON, JAIME A (PSYCHOLOGIST)
Entity type:Individual
Prefix:DR
First Name:JAIME
Middle Name:A
Last Name:CALDERON
Suffix:
Gender:M
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 ESTATES PL
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-2857
Mailing Address - Country:US
Mailing Address - Phone:407-862-7305
Mailing Address - Fax:
Practice Address - Street 1:555 ESTATES PL
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-2857
Practice Address - Country:US
Practice Address - Phone:407-862-7305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-04
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS674103TC0700X
FLSS 674103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical