Provider Demographics
NPI:1568935211
Name:CALLAHAN, JADE LYNAE (MSW)
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:LYNAE
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 FORBES BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-4877
Mailing Address - Country:US
Mailing Address - Phone:301-306-4590
Mailing Address - Fax:301-306-4591
Practice Address - Street 1:4601 FORBES BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-4877
Practice Address - Country:US
Practice Address - Phone:301-306-4590
Practice Address - Fax:301-306-4591
Is Sole Proprietor?:No
Enumeration Date:2019-01-05
Last Update Date:2019-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21172104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker