Provider Demographics
NPI:1871817791
Name:CALVACCA, CAROLYN (LMT)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:CALVACCA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 OLD WILLETS PATH
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-4115
Mailing Address - Country:US
Mailing Address - Phone:631-656-5551
Mailing Address - Fax:
Practice Address - Street 1:922 WHEELER RD
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-2900
Practice Address - Country:US
Practice Address - Phone:631-656-5551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-22
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY27-023802225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist