Provider Demographics
NPI:1386245595
Name:CALLE, LILIANA MARIA (MHC-LP, CASAC)
Entity type:Individual
Prefix:MS
First Name:LILIANA
Middle Name:MARIA
Last Name:CALLE
Suffix:
Gender:F
Credentials:MHC-LP, CASAC
Other - Prefix:
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Mailing Address - Street 1:3286 33RD ST APT E9
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-2156
Mailing Address - Country:US
Mailing Address - Phone:347-493-8599
Mailing Address - Fax:718-828-4899
Practice Address - Street 1:1510 WATERS PL FL 2
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2700
Practice Address - Country:US
Practice Address - Phone:347-493-8559
Practice Address - Fax:718-828-4899
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY19038101YA0400X
NYP103394101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1306906243Medicaid
NY1306906243OtherMEDICAID