Provider Demographics
NPI:1912578535
Name:CALLE, MARIAN DOMINIQUE
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:DOMINIQUE
Last Name:CALLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 ROSEVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07107-1725
Mailing Address - Country:US
Mailing Address - Phone:201-870-5426
Mailing Address - Fax:
Practice Address - Street 1:1090 SAINT NICHOLAS AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3809
Practice Address - Country:US
Practice Address - Phone:212-543-0777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health