Provider Demographics
NPI:1174834352
Name:CALERO-BRECKHEIMER, AYXA (PHD)
Entity Type:Individual
Prefix:
First Name:AYXA
Middle Name:
Last Name:CALERO-BRECKHEIMER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 PAULIN BLVD
Mailing Address - Street 2:
Mailing Address - City:LEONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07605-1236
Mailing Address - Country:US
Mailing Address - Phone:201-585-0757
Mailing Address - Fax:
Practice Address - Street 1:285 W END AVE
Practice Address - Street 2:SUITE 3Y
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-2504
Practice Address - Country:US
Practice Address - Phone:347-435-6498
Practice Address - Fax:646-476-9814
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018429-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY018429-1OtherPSYCHOLOGIST LICENSE