Provider Demographics
NPI:1821546151
Name:JOSEPH P CALLAN LCSW
Entity Type:Organization
Organization Name:JOSEPH P CALLAN LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:CALLAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:813-924-0488
Mailing Address - Street 1:3450 LAKE PADGETT DR
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34639-6514
Mailing Address - Country:US
Mailing Address - Phone:813-924-0488
Mailing Address - Fax:
Practice Address - Street 1:5745 MAIN ST
Practice Address - Street 2:SUITE 204
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-2737
Practice Address - Country:US
Practice Address - Phone:813-924-0488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW1785261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z4276AMedicare PIN