Provider Demographics
NPI:1881013423
Name:KALMAN, TREVOR
Entity Type:Individual
Prefix:MR
First Name:TREVOR
Middle Name:
Last Name:KALMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 W MAIN ST APT H16
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-3153
Mailing Address - Country:US
Mailing Address - Phone:631-214-6083
Mailing Address - Fax:
Practice Address - Street 1:1750 W MAIN ST APT H16
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-3153
Practice Address - Country:US
Practice Address - Phone:631-214-6083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-10
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY72091303104100000X
NY0906451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY104100000XMedicaid