MEDICARE: JOANNE LYNNE CALISTA

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	1041C0700X	Clinical Social Worker		MA
2	1041C0700X	Clinical Social Worker	11111111	MA
3	1041C0700X	Clinical Social Worker	1023257	MA

General Provider Information

NPI Number	:	1518437649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNE LYNNE CALISTA

Provider Business Mailing Address
First Line	:	108 FOREST ST
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01609-1525
Country	:	US
Telephone Number	:	508-757-7927
Fax Number	:

Provider Business Practice Location Address
First Line	:	35 HARVARD ST STE 300
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01609-2828
Country	:	US
Telephone Number	:	508-756-6676
Fax Number	:

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

Provider Enumeration Date	:	12/02/2018
Last Update Date	:	12/02/2018

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Directions to “ JOANNE LYNNE CALISTA ” Practice Location

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