MEDICARE: KALLIRROY KONTOS LCSW-R, CASAC, BCD

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	1041C0700X	Clinical Social Worker	R048155-1	NY

General Provider Information

NPI Number	:	1477793313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KALLIRROY KONTOS LCSW-R, CASAC, BCD

Provider Business Mailing Address
First Line	:	PO BOX 872
Second Line	:
City	:	LINDENHURST
State	:	NY
Zip	:	11757-0872
Country	:	US
Telephone Number	:	631-592-2179
Fax Number	:	631-592-8060

Provider Business Practice Location Address
First Line	:	609 ROUTE 109 STE 1B2
Second Line	:
City	:	WEST BABYLON
State	:	NY
Zip	:	11704-5069
Country	:	US
Telephone Number	:	631-592-2179
Fax Number	:	631-592-8060

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

Provider Enumeration Date	:	03/05/2009
Last Update Date	:	12/01/2021

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