Provider Demographics
NPI:1992095095
Name:CALDERA, LORENA (EDM PSYCH COUNSELI)
Entity type:Individual
Prefix:MS
First Name:LORENA
Middle Name:
Last Name:CALDERA
Suffix:
Gender:F
Credentials:EDM PSYCH COUNSELI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 MACDONALD AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94805-2333
Mailing Address - Country:US
Mailing Address - Phone:510-219-5252
Mailing Address - Fax:
Practice Address - Street 1:4101 MACDONALD AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94805-2333
Practice Address - Country:US
Practice Address - Phone:510-219-5252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 74823106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist