Doctor Name: | DR. TYLER CALABRESE |
NPI Number: | 1174915961 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PSY.D. |
License Number: | 05238 |
Business Practice Address: | 1742 Waldorf Ct Crofton, MD - 211142317 |
Business Phone Number: | 4107905075 |
Business Fax Number: | |
Mailing Address: | 1742 Waldorf Ct, CROFTON |
State: | MD |
Postal Code: | 211142317 |
Phone Number: | 4107905075 |
Fax Number: | |
NPI Enumeration Date: | 03/03/2015 |
NPI Last Update Date: | 03/03/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 05238 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MD |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |