=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700648219
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MS. NATALY CALVO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2024
-----------------------------------------------------
Last Update Date | 01/29/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11669 233RD ST
-----------------------------------------------------
City | CAMBRIA HEIGHTS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11411-1835
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-847-3039
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11526 VAN WYCK EXPY
-----------------------------------------------------
City | SOUTH OZONE PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11420-2230
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-896-2182
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------