Healthcare Provider Details

I. General information

NPI: 1215486402
Provider Name (Legal Business Name): NIKA KALYNOVSKA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2016
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 W JOHNSON AVE STE 104
CHESHIRE CT
06410-4506
US

IV. Provider business mailing address

15339 SATICOY ST
VAN NUYS CA
91406-3345
US

V. Phone/Fax

Practice location:
  • Phone: 203-272-6007
  • Fax:
Mailing address:
  • Phone: 818-267-2681
  • Fax: 818-267-2771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number5214
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: