Provider Demographics
NPI:1730358680
Name:CALDERON-VITAL, DANETA (LCSW)
Entity type:Individual
Prefix:
First Name:DANETA
Middle Name:
Last Name:CALDERON-VITAL
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 1:1530 W CAMERON AVE
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-2711
Mailing Address - Country:US
Mailing Address - Phone:162-699-3300
Mailing Address - Fax:626-856-1560
Practice Address - Street 1:1530 W CAMERON AVE
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-2711
Practice Address - Country:US
Practice Address - Phone:626-993-3000
Practice Address - Fax:626-856-1560
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-25
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS198731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical