Provider Demographics
NPI:1821239856
Name:CALABRO, NICHOLAS ANTHONY (LCSW, CASAC)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:ANTHONY
Last Name:CALABRO
Suffix:
Gender:M
Credentials:LCSW, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6714 41ST AVE
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-8128
Mailing Address - Country:US
Mailing Address - Phone:718-458-4243
Mailing Address - Fax:
Practice Address - Street 1:6714 41ST AVE
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-8128
Practice Address - Country:US
Practice Address - Phone:718-458-4243
Practice Address - Fax:718-458-4481
Is Sole Proprietor?:No
Enumeration Date:2009-03-21
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0792821041C0700X
NY076319104100000X
NY23899101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)