Provider Demographics
NPI:1205578515
Name:CALLAHAN, MICHAEL F
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:F
Last Name:CALLAHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1170 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-2631
Mailing Address - Country:US
Mailing Address - Phone:631-565-0484
Mailing Address - Fax:
Practice Address - Street 1:481 8TH AVE STE 1040
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-1809
Practice Address - Country:US
Practice Address - Phone:212-244-4447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-08
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health