Provider Demographics
NPI:1588799068
Name:CALLANAN, DAVID JEROME (BA, CSC-AD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JEROME
Last Name:CALLANAN
Suffix:
Gender:M
Credentials:BA, CSC-AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 CAMBERLEY CIR
Mailing Address - Street 2:APARTMENT T-2
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-3844
Mailing Address - Country:US
Mailing Address - Phone:410-337-6995
Mailing Address - Fax:
Practice Address - Street 1:6401 YORK RD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-2152
Practice Address - Country:US
Practice Address - Phone:410-887-3828
Practice Address - Fax:410-887-3786
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDSC1103101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)