MEDICARE: MARLENA CALZAVARA LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SW22409	FL

General Provider Information

NPI Number	:	1568290872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARLENA CALZAVARA LCSW

Provider Business Mailing Address
First Line	:	28602 102ND DR E
Second Line	:
City	:	MYAKKA CITY
State	:	FL
Zip	:	34251-9652
Country	:	US
Telephone Number	:	941-320-7031
Fax Number	:

Provider Business Practice Location Address
First Line	:	28602 102ND DR E
Second Line	:
City	:	MYAKKA CITY
State	:	FL
Zip	:	34251-9652
Country	:	US
Telephone Number	:	941-320-7031
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2024
Last Update Date	:	07/26/2024

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