Provider Demographics
NPI:1538515499
Name:MCCALLA, JUDITH REY (PHD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:REY
Last Name:MCCALLA
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 1:15141 SW 159TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33187-6601
Mailing Address - Country:US
Mailing Address - Phone:786-553-7445
Mailing Address - Fax:305-284-1700
Practice Address - Street 1:5665 PONCE DE LEON BLVD
Practice Address - Street 2:#215
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2510
Practice Address - Country:US
Practice Address - Phone:305-284-6778
Practice Address - Fax:305-284-1700
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-10
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5861103TC0700X
103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth