Provider Demographics
NPI:1598947426
Name:CALABRESE, PHYLLIS (LCSW)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:
Last Name:CALABRESE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3251 ROUTE 112
Mailing Address - Street 2:BUILDING #9, SUITE 2
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-1446
Mailing Address - Country:US
Mailing Address - Phone:631-451-6007
Mailing Address - Fax:631-732-1155
Practice Address - Street 1:3251 ROUTE 112
Practice Address - Street 2:BUILDING #9, SUITE 2
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-1446
Practice Address - Country:US
Practice Address - Phone:631-451-6007
Practice Address - Fax:631-732-1155
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0760321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical