Provider Demographics
NPI:1043326143
Name:CALLAHAN, BOYD STEVEN (MSW)
Entity Type:Individual
Prefix:MR
First Name:BOYD
Middle Name:STEVEN
Last Name:CALLAHAN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:479 N NORTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-3254
Mailing Address - Country:US
Mailing Address - Phone:847-698-2862
Mailing Address - Fax:847-698-0928
Practice Address - Street 1:701 E IRVING PARK RD
Practice Address - Street 2:STE 305
Practice Address - City:ROSELLE
Practice Address - State:IL
Practice Address - Zip Code:60172-2322
Practice Address - Country:US
Practice Address - Phone:630-529-1644
Practice Address - Fax:630-529-1792
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02215410OtherBLUE CROSS PROVIDER NUMBE