Provider Demographics
NPI:1699484642
Name:CALDERON BENITEZ, JEAN ALYSSA (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:ALYSSA
Last Name:CALDERON BENITEZ
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 18
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-0018
Mailing Address - Country:US
Mailing Address - Phone:787-690-6335
Mailing Address - Fax:
Practice Address - Street 1:1 RICHMOND SQ STE 333W
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-5156
Practice Address - Country:US
Practice Address - Phone:140-122-7037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2278571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical