Basic Information
Provider Information
NPI: 1659559326
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CALABRO
FirstName: JULIE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: LCSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 69 WOODLAND ST
Address2:  
City: NEWINGTON
State: CT
PostalCode: 061112362
CountryCode: US
TelephoneNumber: 8606664359
FaxNumber:  
Practice Location
Address1: 587 E MIDDLE TPKE
Address2:  
City: MANCHESTER
State: CT
PostalCode: 060403731
CountryCode: US
TelephoneNumber: 8606463888
FaxNumber: 8606454132
Other Information
ProviderEnumerationDate: 02/05/2008
LastUpdateDate: 07/17/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700X007068CTY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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