Provider Demographics
NPI:1861928046
Name:KALOGIANNIS, DIMITRIOS E (LCSW)
Entity type:Individual
Prefix:
First Name:DIMITRIOS
Middle Name:E
Last Name:KALOGIANNIS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4320 NW 94TH TER
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-7603
Mailing Address - Country:US
Mailing Address - Phone:561-212-7998
Mailing Address - Fax:
Practice Address - Street 1:4320 NW 94TH TER
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-7603
Practice Address - Country:US
Practice Address - Phone:561-212-7998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-07
Last Update Date:2021-05-10
Deactivation Date:2020-11-10
Deactivation Code:
Reactivation Date:2021-05-10
Provider Licenses
StateLicense IDTaxonomies
FLSW91891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical