Provider Demographics
NPI:1013054162
Name:TZIKAS, PAULA CALABRESE (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAULA
Middle Name:CALABRESE
Last Name:TZIKAS
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 1:11 STEWART AVE
Mailing Address - Street 2:
Mailing Address - City:STEWART MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:11530-2208
Mailing Address - Country:US
Mailing Address - Phone:917-509-7323
Mailing Address - Fax:
Practice Address - Street 1:11 STEWART AVE
Practice Address - Street 2:
Practice Address - City:STEWART MANOR
Practice Address - State:NY
Practice Address - Zip Code:11530-2208
Practice Address - Country:US
Practice Address - Phone:917-509-7323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015149103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist