Provider Demographics
NPI:1386831048
Name:CALVERT, JOAN M (EDD, LMFT)
Entity type:Individual
Prefix:DR
First Name:JOAN
Middle Name:M
Last Name:CALVERT
Suffix:
Gender:F
Credentials:EDD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 N MOUNTAIN RD STE A110
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-1412
Mailing Address - Country:US
Mailing Address - Phone:860-916-9496
Mailing Address - Fax:
Practice Address - Street 1:705 N MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-1412
Practice Address - Country:US
Practice Address - Phone:860-953-0453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001220106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001220OtherSTATE LICENSE NUMBER