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General NPI Number Information
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NPI Number | 1730214628
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Entity Type | Individual
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Provider Name | RICHARD D. CALVERT MSW, ACSW, LCSW (CT)
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Gender | Male
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 255 HEMPSTEAD ST CHILD AND FAMILY AGENCY OF SOUTHEASTERN CT, INC.
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City | NEW LONDON
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State | CT
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Zip | 06320-6204
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Country | US
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Telephone | 860-442-2797
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Fax |
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Provider Business Mailing Address
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Address Line | 18 HAPPY ACRES RD
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City | CLINTON
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State | CT
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Zip | 06413-1332
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Country | US
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Telephone | 860-442-2797
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 001513
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License Number State | CT
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