MEDICARE: AVRAHAM CALEV PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	0109532	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396780714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AVRAHAM CALEV PH.D.

Provider Business Mailing Address
First Line	:	111 SMITHTOWN BYP
Second Line	:	SUITE 119
City	:	HAUPPAUGE
State	:	NY
Zip	:	11788-2524
Country	:	US
Telephone Number	:	631-361-7389
Fax Number	:	631-246-5469

Provider Business Practice Location Address
First Line	:	152 ISLIP AVE
Second Line	:	SUITE 23
City	:	ISLIP
State	:	NY
Zip	:	11751-3225
Country	:	US
Telephone Number	:	631-361-7389
Fax Number	:	631-361-7389

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	12/30/2007

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