Provider Demographics
NPI:1871722371
Name:CALVIT, STEPHEN EUGENE (LICSW)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:EUGENE
Last Name:CALVIT
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2649 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1006
Mailing Address - Country:US
Mailing Address - Phone:612-676-1604
Mailing Address - Fax:612-379-8235
Practice Address - Street 1:2649 PARK AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1006
Practice Address - Country:US
Practice Address - Phone:612-676-1604
Practice Address - Fax:612-379-8235
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN86671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical