Provider Demographics
NPI:1659724011
Name:KALATA, DOMINIQUE (LCSW; LICSW)
Entity type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:
Last Name:KALATA
Suffix:
Gender:F
Credentials:LCSW; LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-8364
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:140 2ND AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-8364
Practice Address - Country:US
Practice Address - Phone:917-660-8047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-20
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1279711041C0700X
CA1309381041C0700X
NY0967411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA127971OtherASSOCIATION OF SOCIAL WORK BOARDS FOR THE MASSACHUSETTS BOARD
NY096741OtherNYSED OFFICE OF THE PROFESSIONS
CA130938OtherBOARD OF BEHAVIORAL SCIENCES