MEDICARE: DR. CALLIOPE CALLIAS 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	015125	NY

General Provider Information

NPI Number	:	1568509560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CALLIOPE CALLIAS PH.D.

Provider Business Mailing Address
First Line	:	3412 36TH STREET
Second Line	:	SUITE 3/201
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11106-1200
Country	:	US
Telephone Number	:	917-887-2698
Fax Number	:

Provider Business Practice Location Address
First Line	:	3412 36TH STREET
Second Line	:	SUITE 3/201
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11106-1200
Country	:	US
Telephone Number	:	917-887-2698
Fax Number	:

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

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	05/24/2017

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