Provider Demographics
NPI:1295270445
Name:CALLEO, CAROLYN (CRNP-PMH)
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:
Last Name:CALLEO
Suffix:
Gender:F
Credentials:CRNP-PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 SOLAREX CT
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-7005
Mailing Address - Country:US
Mailing Address - Phone:301-663-8263
Mailing Address - Fax:301-682-5326
Practice Address - Street 1:604 SOLAREX CT
Practice Address - Street 2:SUITE 201
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-7005
Practice Address - Country:US
Practice Address - Phone:301-663-8263
Practice Address - Fax:301-682-5326
Is Sole Proprietor?:No
Enumeration Date:2016-12-27
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR191108363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health