MEDICARE: NELSON LEONEL CALDERON JR. LCSW

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	81122	CA

General Provider Information

NPI Number	:	1952558157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NELSON LEONEL CALDERON JR. LCSW

Provider Business Mailing Address
First Line	:	2640 INDUSTRY WAY STE B
Second Line	:
City	:	LYNWOOD
State	:	CA
Zip	:	90262-4285
Country	:	US
Telephone Number	:	310-627-4525
Fax Number	:

Provider Business Practice Location Address
First Line	:	2640 INDUSTRY WAY STE B
Second Line	:
City	:	LYNWOOD
State	:	CA
Zip	:	90262-4285
Country	:	US
Telephone Number	:	310-627-4525
Fax Number	:	310-627-4531

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

Provider Enumeration Date	:	08/19/2008
Last Update Date	:	08/11/2023

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