Provider Demographics
NPI:1952461410
Name:CALKINS, LAURI ELLEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAURI
Middle Name:ELLEN
Last Name:CALKINS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 WEST 93RD STREET
Mailing Address - Street 2:APT 9K
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025
Mailing Address - Country:US
Mailing Address - Phone:212-666-8566
Mailing Address - Fax:
Practice Address - Street 1:183RD STREET & 3RD AVENUE
Practice Address - Street 2:ST. BARNABAS HOSPITAL
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457
Practice Address - Country:US
Practice Address - Phone:718-960-6159
Practice Address - Fax:718-960-3272
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0142211103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02733397Medicaid
NYVN1221Medicare ID - Type Unspecified