Mara Calderon, PHD
Individual provider Active NPI Clinical Psychologist · Charleston, SC
NPI 1174738280 · NPPES record last updated Feb 16, 2010
Key facts
- NPI
- 1174738280
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 450 (SC)
- Practice address
- 1662 Ingram Rd
Charleston, SC 29407 - Phone
- (843) 402-9115
- Fax
- (843) 402-5407
- NPI assigned
- May 11, 2007
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 450 | SC | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Charleston Geriatrics and Post - Acute Care LLC | Past | Accepting new patients | |
| Catholic Chrities Counseling | Clinical | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 450 | SC | Yes |
Addresses
Primary practice location
1662 Ingram Rd
Charleston, SC 29407
Mailing address
1662 Ingram Rd
Charleston, SC 29407
Phone (843) 402-9115
Other providers in Charleston, SC
- Kristin Rebecca Calandra
- Claire Pryor Calcagno
- Nicholas Calcagno
- Robert Dudley Calcote
- Kellie Rae Calderon
- Robyn Lindsey Caldwell Bellavia
- Jarred Caldwell
- Jennifer G Caldwell
- Katharine Emily Caldwell
- Kenneth M Caldwell
All providers in Charleston, SC · Clinical Psychologist in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 16, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.