Provider Demographics
NPI:1477793313
Name:KONTOS, KALLIRROY (LCSW-R, CASAC, BCD)
Entity Type:Individual
Prefix:
First Name:KALLIRROY
Middle Name:
Last Name:KONTOS
Suffix:
Gender:F
Credentials:LCSW-R, CASAC, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 872
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-0872
Mailing Address - Country:US
Mailing Address - Phone:631-592-2179
Mailing Address - Fax:631-592-8060
Practice Address - Street 1:609 ROUTE 109 STE 1B2
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-5069
Practice Address - Country:US
Practice Address - Phone:631-592-2179
Practice Address - Fax:631-592-8060
Is Sole Proprietor?:No
Enumeration Date:2009-03-05
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR048155-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400086697Medicare PIN