Provider Demographics
NPI:1174830871
Name:KALOGRIDIS, JOANNA (MA)
Entity Type:Individual
Prefix:MS
First Name:JOANNA
Middle Name:
Last Name:KALOGRIDIS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7164 168TH ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11365-3242
Mailing Address - Country:US
Mailing Address - Phone:718-591-8100
Mailing Address - Fax:719-969-2941
Practice Address - Street 1:7164 168TH ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11365-3242
Practice Address - Country:US
Practice Address - Phone:718-591-8100
Practice Address - Fax:719-969-2941
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-02
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1172411103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1172411OtherCERTIFICATION