Healthcare Provider Details

I. General information

NPI: 1861497554
Provider Name (Legal Business Name): PAUL CALDARELLA PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 COUNTRY HILLS DR STE 8
OGDEN UT
84403-2467
US

IV. Provider business mailing address

1460 MAPLE ST
OGDEN UT
84403-2146
US

V. Phone/Fax

Practice location:
  • Phone: 801-475-0402
  • Fax:
Mailing address:
  • Phone: 801-622-5779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3789262501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: