Healthcare Provider Details

I. General information

NPI: 1568290872
Provider Name (Legal Business Name): MARLENA CALZAVARA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2024
Last Update Date: 07/26/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28602 102ND DR E
MYAKKA CITY FL
34251-9652
US

IV. Provider business mailing address

28602 102ND DR E
MYAKKA CITY FL
34251-9652
US

V. Phone/Fax

Practice location:
  • Phone: 941-320-7031
  • Fax:
Mailing address:
  • Phone: 941-320-7031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW22409
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: