Provider Demographics
NPI:1437310745
Name:CALLENS, CHARLOTTE L (MA PHD MSC)
Entity Type:Individual
Prefix:DR
First Name:CHARLOTTE
Middle Name:L
Last Name:CALLENS
Suffix:
Gender:F
Credentials:MA PHD MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 FORBES STREET,
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401
Mailing Address - Country:US
Mailing Address - Phone:443-624-4048
Mailing Address - Fax:410-266-3929
Practice Address - Street 1:104 FORBES STREET,
Practice Address - Street 2:SUITE 205
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401
Practice Address - Country:US
Practice Address - Phone:443-624-4048
Practice Address - Fax:410-266-3929
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-19
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01211103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD404112700Medicaid