Provider Demographics
NPI:1235354598
Name:CALLAN, TRISSY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:TRISSY
Middle Name:
Last Name:CALLAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 E 12TH ST
Mailing Address - Street 2:APT 3A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-7221
Mailing Address - Country:US
Mailing Address - Phone:212-475-1234
Mailing Address - Fax:
Practice Address - Street 1:156 5TH AVE
Practice Address - Street 2:SUITE 916
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-7002
Practice Address - Country:US
Practice Address - Phone:212-475-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-052142-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN5G401Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID