Basic Information
| Provider Information | |||||||||
| NPI: | 1952461410 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CALKINS | ||||||||
| FirstName: | LAURI | ||||||||
| MiddleName: | ELLEN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 175 WEST 93RD STREET | ||||||||
| Address2: | APT 9K | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2126668566 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 183RD STREET & 3RD AVENUE | ||||||||
| Address2: | ST. BARNABAS HOSPITAL | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189606159 | ||||||||
| FaxNumber: | 7189603272 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 0142211 | NY | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 02733397 | 05 | NY | MEDICAID |