Provider Demographics
NPI:1730247891
Name:KALLIO, JANE P (LCSW)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:P
Last Name:KALLIO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7605 FOREST AVE STE 414
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-4941
Mailing Address - Country:US
Mailing Address - Phone:804-319-0128
Mailing Address - Fax:804-592-5301
Practice Address - Street 1:7605 FOREST AVE STE 414
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-4941
Practice Address - Country:US
Practice Address - Phone:804-319-0128
Practice Address - Fax:804-592-5301
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040046671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008953546Medicaid
VA008953546Medicaid