Basic Information
Provider Information
NPI: 1811906167
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CALCATERRA
FirstName: ANGELA
MiddleName: J
NamePrefix: MS.
NameSuffix:  
Credential: LCSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: O'NEIL
OtherFirstName: ANGELA
OtherMiddleName: J
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: LCSW
OtherLastNameType: 1
Mailing Information
Address1: PO BOX 1045
Address2:  
City: SEWARD
State: AK
PostalCode: 996642106
CountryCode: US
TelephoneNumber: 9072245257
FaxNumber: 9072247081
Practice Location
Address1: 10018 KENNERLY RD
Address2:  
City: SAINT LOUIS
State: MO
PostalCode: 631282106
CountryCode: US
TelephoneNumber: 3145254412
FaxNumber: 3145254420
Other Information
ProviderEnumerationDate: 08/05/2006
LastUpdateDate: 08/23/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700X100071AKN Behavioral Health & Social Service ProvidersSocial WorkerClinical
1041C0700X2001017180MOY Behavioral Health & Social Service ProvidersSocial WorkerClinical

ID Information
IDTypeStateIssuerDescription
10007105AK MEDICAID


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