Provider Demographics
NPI:1104020874
Name:CALLAHAN, ANNETTE RICKERT (LSCWC)
Entity Type:Individual
Prefix:MS
First Name:ANNETTE
Middle Name:RICKERT
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:LSCWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 MAIN ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-1904
Mailing Address - Country:US
Mailing Address - Phone:410-526-5387
Mailing Address - Fax:410-526-9834
Practice Address - Street 1:1501 S CLINTON ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-5730
Practice Address - Country:US
Practice Address - Phone:443-805-5598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD109711041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker