Provider Demographics
NPI:1164737482
Name:CALLAIN, MARY ROSE (LCSW, LADC)
Entity Type:Individual
Prefix:MS
First Name:MARY ROSE
Middle Name:
Last Name:CALLAIN
Suffix:
Gender:F
Credentials:LCSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:899 RIVERSIDE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-1070
Mailing Address - Country:US
Mailing Address - Phone:207-871-1200
Mailing Address - Fax:207-871-1232
Practice Address - Street 1:32 SPURWINK LN
Practice Address - Street 2:
Practice Address - City:CORNVILLE
Practice Address - State:ME
Practice Address - Zip Code:04976-6257
Practice Address - Country:US
Practice Address - Phone:207-858-0252
Practice Address - Fax:207-858-0276
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC862101YA0400X
MELC34711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)