Provider Demographics
NPI:1881644169
Name:CALLENDER, VESTA (BA;MA; MS)
Entity Type:Individual
Prefix:MS
First Name:VESTA
Middle Name:
Last Name:CALLENDER
Suffix:
Gender:F
Credentials:BA;MA; MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 GLENBROOK RD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-2970
Mailing Address - Country:US
Mailing Address - Phone:203-353-9903
Mailing Address - Fax:
Practice Address - Street 1:211 W 56TH ST
Practice Address - Street 2:18J
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-4321
Practice Address - Country:US
Practice Address - Phone:212-247-5334
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0708151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN36E71Medicare ID - Type Unspecified