Provider Demographics
NPI:1699175257
Name:KALLNER, MIKA (LMSW)
Entity Type:Individual
Prefix:MS
First Name:MIKA
Middle Name:
Last Name:KALLNER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 W 251ST ST
Mailing Address - Street 2:APT. 3J
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-3042
Mailing Address - Country:US
Mailing Address - Phone:914-705-1835
Mailing Address - Fax:
Practice Address - Street 1:936 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-6013
Practice Address - Country:US
Practice Address - Phone:914-705-1835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-01
Last Update Date:2014-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist