Provider Demographics
NPI:1578803391
Name:CALLAHAN, KENNETH FRANCIS (LCSW-R)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:FRANCIS
Last Name:CALLAHAN
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414A GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-2421
Mailing Address - Country:US
Mailing Address - Phone:718-399-0137
Mailing Address - Fax:718-732-0634
Practice Address - Street 1:414A GRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-2421
Practice Address - Country:US
Practice Address - Phone:718-399-0137
Practice Address - Fax:718-732-0634
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-15
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0363421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical