Provider Demographics
NPI:1861443756
Name:CALLAHAN, SUSAN KENNEDY (LCSW, LCAC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:KENNEDY
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:LCSW, LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 STOCKBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-8822
Mailing Address - Country:US
Mailing Address - Phone:317-697-4283
Mailing Address - Fax:
Practice Address - Street 1:601 STOCKBRIDGE DR
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-8822
Practice Address - Country:US
Practice Address - Phone:317-697-4283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INC290101YA0400X
IN340012661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100270530Medicaid
IN150074Medicare PIN
IN100270530Medicaid