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General NPI Number Information
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NPI Number | 1104114156
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Entity Type | Individual
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Provider Name | LEONARD FRED CALTABIANO PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 07/12/2011
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Last Update Date | 07/12/2011
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Provider Practice Location Address
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Address Line | 300 GARDEN CITY PLZ STE 350
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City | GARDEN CITY
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State | NY
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Zip | 11530-3358
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Country | US
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Telephone | 516-747-9030
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Fax | 516-877-0998
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Provider Business Mailing Address
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Address Line | 104 ADAM ST
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City | NORTH MASSAPEQUA
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State | NY
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Zip | 11758-1603
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Country | US
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Telephone | 516-586-5319
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 019152
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License Number State | NY
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