Provider Demographics
NPI:1962769752
Name:KALETA, VERONICA FLEMING (LCSW)
Entity type:Individual
Prefix:MS
First Name:VERONICA
Middle Name:FLEMING
Last Name:KALETA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 DUNDERBERG RD
Mailing Address - Street 2:
Mailing Address - City:CENTRAL VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10917-3507
Mailing Address - Country:US
Mailing Address - Phone:845-460-6400
Mailing Address - Fax:845-460-6041
Practice Address - Street 1:199 DUNDERBERG RD
Practice Address - Street 2:
Practice Address - City:CENTRAL VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10917-3507
Practice Address - Country:US
Practice Address - Phone:845-460-6400
Practice Address - Fax:845-460-6041
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY073375-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY117172Medicaid