Provider Demographics
NPI:1467825695
Name:DENNIS-POWELL, CALESA
Entity Type:Individual
Prefix:
First Name:CALESA
Middle Name:
Last Name:DENNIS-POWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CALESA
Other - Middle Name:
Other - Last Name:DENNIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:464 COMMONWEALTH
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473
Mailing Address - Country:US
Mailing Address - Phone:646-571-9609
Mailing Address - Fax:
Practice Address - Street 1:464 COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-3603
Practice Address - Country:US
Practice Address - Phone:646-571-9609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-10
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst