Provider Demographics
NPI:1568509560
Name:CALLIAS, CALLIOPE (PHD)
Entity Type:Individual
Prefix:DR
First Name:CALLIOPE
Middle Name:
Last Name:CALLIAS
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 1:3412 36TH STREET
Mailing Address - Street 2:SUITE 3/201
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11106-1200
Mailing Address - Country:US
Mailing Address - Phone:917-887-2698
Mailing Address - Fax:
Practice Address - Street 1:3412 36TH STREET
Practice Address - Street 2:SUITE 3/201
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11106-1200
Practice Address - Country:US
Practice Address - Phone:917-887-2698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2017-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015125103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05242Medicare PIN