Provider Demographics
NPI:1063027415
Name:CALLOWAY, AMBER LYN (PHD)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:LYN
Last Name:CALLOWAY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 S 19TH ST UNIT 1B
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-1415
Mailing Address - Country:US
Mailing Address - Phone:770-330-8648
Mailing Address - Fax:
Practice Address - Street 1:940 E HAVERFORD RD STE 301
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3859
Practice Address - Country:US
Practice Address - Phone:610-455-5757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-12
Last Update Date:2020-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS018965103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical