MEDICARE: DANIELLE CALVERT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1396597662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE CALVERT

Provider Business Mailing Address
First Line	:	833 LUCAS ST APT J
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29730-4178
Country	:	US
Telephone Number	:	843-325-3218
Fax Number	:

Provider Business Practice Location Address
First Line	:	2784 FAITH BLVD
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29730-9093
Country	:	US
Telephone Number	:	843-325-3218
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2024
Last Update Date	:	04/02/2024

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Directions to “ DANIELLE CALVERT ” Practice Location

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