Provider Demographics
NPI:1821092404
Name:CALLENDER, CATHERINE E (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:E
Last Name:CALLENDER
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 1:134 FAIRMONT ST
Mailing Address - Street 2:STE. E
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-4739
Mailing Address - Country:US
Mailing Address - Phone:601-925-8194
Mailing Address - Fax:601-925-8496
Practice Address - Street 1:134 FAIRMONT ST
Practice Address - Street 2:STE. E
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-4739
Practice Address - Country:US
Practice Address - Phone:601-925-8194
Practice Address - Fax:601-925-8196
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC3503104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00123406Medicaid
MSQ12227Medicare UPIN
MS800000269Medicare ID - Type UnspecifiedPROVIDER ID