Provider Demographics
NPI:1619573847
Name:KALISCH, CAREN (RN)
Entity Type:Individual
Prefix:
First Name:CAREN
Middle Name:
Last Name:KALISCH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 GLENVILLE ST
Mailing Address - Street 2:UNIT 106
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06831
Mailing Address - Country:US
Mailing Address - Phone:203-869-3022
Mailing Address - Fax:
Practice Address - Street 1:12 GLENVILLE ST
Practice Address - Street 2:UNIT 106
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06831
Practice Address - Country:US
Practice Address - Phone:203-869-3022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY548731-01163W00000X
CT10-78150163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty