Provider Demographics
NPI:1275788812
Name:CALLAHAN, LISA MARIE
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARIE
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:DEVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:75 HENRY ST
Mailing Address - Street 2:APT. 11-L
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-1752
Mailing Address - Country:US
Mailing Address - Phone:516-521-0075
Mailing Address - Fax:
Practice Address - Street 1:75 HENRY ST
Practice Address - Street 2:APT. 11-L
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-1752
Practice Address - Country:US
Practice Address - Phone:516-521-0075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011990-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist