Provider Demographics
NPI:1174009427
Name:CALLOWAY, VINCENT LAWRENCE (MSS, LCSW, CEAP)
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:LAWRENCE
Last Name:CALLOWAY
Suffix:
Gender:M
Credentials:MSS, LCSW, CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1989 N. 63RD ST., SUITE 200
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19151
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1989 N 63RD ST STE 200
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19151-2607
Practice Address - Country:US
Practice Address - Phone:215-878-1258
Practice Address - Fax:215-878-8998
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-18
Last Update Date:2020-02-27
Deactivation Date:2020-02-25
Deactivation Code:
Reactivation Date:2020-02-27
Provider Licenses
StateLicense IDTaxonomies
PACW0195051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical