MEDICARE: MS. PAMELA CALVANO L. M. F. T.

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	106H00000X	Marriage & Family Therapist	35000777A	IN

General Provider Information

NPI Number	:	1598973968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PAMELA CALVANO L. M. F. T.

Provider Business Mailing Address
First Line	:	2288 YANKEE ST
Second Line	:
City	:	NILES
State	:	MI
Zip	:	49120-3903
Country	:	US
Telephone Number	:	574-287-1879
Fax Number	:	574-234-6025

Provider Business Practice Location Address
First Line	:	818 E JEFFERSON BLVD
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46617-2905
Country	:	US
Telephone Number	:	574-287-1879
Fax Number	:	574-234-6025

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

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	07/08/2007

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