Provider Demographics
NPI:1306394283
Name:CALLAHAN, DANIEL J (MCAP, MSW, ICRC-ADC)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:J
Last Name:CALLAHAN
Suffix:
Gender:M
Credentials:MCAP, MSW, ICRC-ADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18070 S TAMIAMI TRL STE 11
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-4602
Mailing Address - Country:US
Mailing Address - Phone:239-687-9198
Mailing Address - Fax:
Practice Address - Street 1:18070 S TAMIAMI TRL STE 11
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4602
Practice Address - Country:US
Practice Address - Phone:239-687-9198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-20
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL100046101YA0400X
FLCAP100046101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100046OtherMCAP