Provider Demographics
NPI:1790845469
Name:CALLOWAY, GENOVEVA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:GENOVEVA
Middle Name:
Last Name:CALLOWAY
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 1:1529 COSTA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806-4719
Mailing Address - Country:US
Mailing Address - Phone:510-374-3490
Mailing Address - Fax:510-374-7274
Practice Address - Street 1:256 24TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94804-1804
Practice Address - Country:US
Practice Address - Phone:510-374-3467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS103861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical