Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 35SJ00467100 | NJ |
Y | 103T00000X | Psychologist | 35SJ00467100 | NJ |
NPI | 1013248459 |
---|---|
Provider Name | Dr. Jacqueline A. Calle-Andrade |
First Address | Hillside, NJ 07205-2818 |
Second Address | Livingston, NJ 07039-1710 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2010 |
Last Update Date | 25/01/2010 |