=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225138233
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REBECCA G CALABRESE LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 51 LAKESIDE BOULEVARD EAST
-----------------------------------------------------
City | WATERBURY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-753-9743
-----------------------------------------------------
Fax | 203-286-1293
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 51 LAKESIDE BOULEVARD EAST
-----------------------------------------------------
City | WATERBURY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-753-9743
-----------------------------------------------------
Fax | 203-286-1293
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 002791
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------