Provider Demographics
NPI:1114190998
Name:CALHOUN, ELIZA (MS)
Entity Type:Individual
Prefix:MS
First Name:ELIZA
Middle Name:
Last Name:CALHOUN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 DECATUR ST
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-2598
Mailing Address - Country:US
Mailing Address - Phone:718-578-9813
Mailing Address - Fax:
Practice Address - Street 1:132 DECATUR ST
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216
Practice Address - Country:US
Practice Address - Phone:718-578-9813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY085173104100000X
NY004614101YM0800X
DCLC500813621041C0700X
VA09040099801041C0700X
MD227411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health