Basic Information
| Provider Information | |||||||||
| NPI: | 1982905535 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CALVO | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | M.ED.. BCBA, LABA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 321 FORTUNE BLVD | ||||||||
| Address2: | |||||||||
| City: | MILFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017571750 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5084780207 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 321 FORTUNE BLVD STE 202 | ||||||||
| Address2: | |||||||||
| City: | MILFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017571750 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5084780207 | ||||||||
| FaxNumber: | 5086346984 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2010 | ||||||||
| LastUpdateDate: | 03/04/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 222Q00000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Developmental Therapist | 103K00000X | 3003 | MA | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.