Provider Demographics
NPI:1467296475
Name:CALDERA, BENJAMIN (BA, CAS)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:CALDERA
Suffix:
Gender:M
Credentials:BA, CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 E IDAHO SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81007-2715
Mailing Address - Country:US
Mailing Address - Phone:719-334-0826
Mailing Address - Fax:
Practice Address - Street 1:805 W 4TH ST
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2305
Practice Address - Country:US
Practice Address - Phone:720-306-8266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACC.0021144101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)