Provider Demographics
NPI:1982750675
Name:CALEJO, MARIA O (ITDS)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:O
Last Name:CALEJO
Suffix:
Gender:F
Credentials:ITDS
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Mailing Address - Street 1:1601 NW 12 AVE
Mailing Address - Street 2:UNIVERSITY OF MIAMI - EARLY STEPS PROGRAM
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136
Mailing Address - Country:US
Mailing Address - Phone:305-243-6660
Mailing Address - Fax:305-243-3501
Practice Address - Street 1:1601 NW 12 AVE
Practice Address - Street 2:UNIVERSITY OF MIAMI - EARLY STEPS PROGRAM
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136
Practice Address - Country:US
Practice Address - Phone:305-243-6660
Practice Address - Fax:305-243-3501
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
FL103TE1000X103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL811232100Medicaid