Provider Demographics
NPI:1942549233
Name:MCCALLION, THEA BARBARA (LAC, MSTOM)
Entity Type:Individual
Prefix:MRS
First Name:THEA
Middle Name:BARBARA
Last Name:MCCALLION
Suffix:
Gender:F
Credentials:LAC, MSTOM
Other - Prefix:
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Mailing Address - Street 1:80 BROAD STREET
Mailing Address - Street 2:SUITE 1401
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10004
Mailing Address - Country:US
Mailing Address - Phone:212-943-4999
Mailing Address - Fax:212-943-1999
Practice Address - Street 1:80 BROAD STREET
Practice Address - Street 2:SUITE 1401
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004
Practice Address - Country:US
Practice Address - Phone:212-943-4999
Practice Address - Fax:212-943-1999
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-06
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002293-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist