Provider Demographics
NPI:1417323429
Name:CALIXTE, VICTORY (MA IN SP ED)
Entity Type:Individual
Prefix:MRS
First Name:VICTORY
Middle Name:
Last Name:CALIXTE
Suffix:
Gender:F
Credentials:MA IN SP ED
Other - Prefix:MRS
Other - First Name:VICTORIE
Other - Middle Name:
Other - Last Name:CALIXTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA IN SP ED
Mailing Address - Street 1:8907 AVENUE L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-4720
Mailing Address - Country:US
Mailing Address - Phone:718-594-3391
Mailing Address - Fax:
Practice Address - Street 1:8907 AVENUE L
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-4720
Practice Address - Country:US
Practice Address - Phone:718-594-3391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-13
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY762585171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor