Provider Demographics
NPI:1093779498
Name:CALLAHAN, JAY (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:
Last Name:CALLAHAN
Suffix:
Gender:M
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 E WASHINGTON ST
Mailing Address - Street 2:SUITE 2801
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-2103
Mailing Address - Country:US
Mailing Address - Phone:312-372-4823
Mailing Address - Fax:312-372-4822
Practice Address - Street 1:55 E WASHINGTON ST
Practice Address - Street 2:SUITE 2801
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-2103
Practice Address - Country:US
Practice Address - Phone:312-372-4823
Practice Address - Fax:312-372-4822
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-13
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
IL383310Medicare ID - Type Unspecified