Charles J.Kallick, M.D.,PC

Primary specialty

PsychoanalystTaxonomy code 102L00000X

License

011345 Issued in CT

Legal business name

CHARLES J.KALLICK, M.D.,PC

Practice address

12 Crooked Mile Rd
Westport, CT 06880-1123

Phone

(203) 226-3685

NPI assigned

Dec 14, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Charles John Kallick, M.D.

Title

President

Phone

(203) 226-3685

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1323820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323820800000",
    "number": "1902175391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 CROOKED MILE RD",
            "city": "WESTPORT",
            "state": "CT",
            "postal_code": "068801123",
            "telephone_number": "203-226-3685"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 CROOKED MILE RD",
            "city": "WESTPORT",
            "state": "CT",
            "postal_code": "068801123",
            "telephone_number": "203-226-3685"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES J.KALLICK, M.D.,PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-14",
        "last_updated": "2011-12-14",
        "status": "A",
        "authorized_official_last_name": "KALLICK",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "203-226-3685",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "102L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychoanalyst",
            "state": "CT",
            "license": "011345",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychoanalyst in Westport, CT
• Providers in Westport, CT by specialty
• Psychoanalyst in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.