Provider Demographics
NPI:1609278159
Name:CALLAWAY, CHARLES J (MA, LSW)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:J
Last Name:CALLAWAY
Suffix:
Gender:M
Credentials:MA, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 PLEASANT ST
Mailing Address - Street 2:SUITE 115
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-2570
Mailing Address - Country:US
Mailing Address - Phone:508-223-4691
Mailing Address - Fax:
Practice Address - Street 1:607 PLEASANT ST
Practice Address - Street 2:SUITE 115
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-2570
Practice Address - Country:US
Practice Address - Phone:508-223-4691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3028196104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker