Healthcare Provider Details

I. General information

NPI: 1932892676
Provider Name (Legal Business Name): KRISTEL CALDERON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2023
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 BASIN DR STE 190
KEARNY NJ
07032-6521
US

IV. Provider business mailing address

124 SPRINGFIELD RD
LINDEN NJ
07036-4832
US

V. Phone/Fax

Practice location:
  • Phone: 973-982-6278
  • Fax:
Mailing address:
  • Phone: 732-956-1080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06224400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904019001
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: