| |
20 Portwest Ct Saint Charles MO 63303-5985 | |
(636) 578-2836 | |
(877) 433-3107 |
Full Name | |
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Speciality | Social Worker |
Location | 20 Portwest Ct, Saint Charles, Missouri |
Authorized Official Name and Position | Patricka Ann Caldera (OWNER/LCSW) |
Authorized Official Contact | 6365782836 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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20 Portwest Ct Saint Charles MO 63303-5985 Ph: (636) 578-2836 | 20 Portwest Ct Saint Charles MO 63303-5985 Ph: (636) 578-2836 |
NPI Number | 1790001139 |
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Provider Enumeration Date | 04/09/2010 |
Last Update Date | 11/05/2024 |
Certification Date | 11/05/2024 |
Medicare PECOS PAC ID | 2769653294 |
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Medicare Enrollment ID | O20110914000049 |
Identifier | Type | State | Issuer |
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1790001139 | NPI | - | NPPES |
000000631722 | Other | IL | BCBSIL |
999018 | Other | IL | HEALTHLINK |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1041C0700X | Social Worker - Clinical | 2010010537 (Missouri) | Primary |
261Q00000X | Clinic/center | 2010010537 (Missouri) | Secondary |
Provider Name | Patricka A Caldera |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1205007903 PECOS PAC ID: 4486825916 Enrollment ID: I20110914000064 |
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