Provider Demographics
NPI:1700888674
Name:CALVERT, QUENTIN (CSW)
Entity type:Individual
Prefix:
First Name:QUENTIN
Middle Name:
Last Name:CALVERT
Suffix:
Gender:M
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:25925 TELEGRAPH RD
Mailing Address - Street 2:210
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-2518
Mailing Address - Country:US
Mailing Address - Phone:248-746-0342
Mailing Address - Fax:248-746-0308
Practice Address - Street 1:22255 GREENFIELD RD
Practice Address - Street 2:132
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3710
Practice Address - Country:US
Practice Address - Phone:248-849-3301
Practice Address - Fax:248-849-5378
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010179441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5301002923OtherLLP
MIN13630018Medicare ID - Type Unspecified