Provider Demographics
NPI:1710219332
Name:CALLAHAN, KATHY ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KATHY ANN
Middle Name:
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:573 PINES LAKE DR E
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-5117
Mailing Address - Country:US
Mailing Address - Phone:201-213-7862
Mailing Address - Fax:973-248-6585
Practice Address - Street 1:573 PINES LAKE DR E
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-5117
Practice Address - Country:US
Practice Address - Phone:201-213-7862
Practice Address - Fax:973-248-6585
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-07
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ 44SC014864001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ11954845OtherCAQH