Provider Demographics
NPI:1336356518
Name:CALLAHAN, DOMINIC JOHANNES (PHD)
Entity Type:Individual
Prefix:
First Name:DOMINIC
Middle Name:JOHANNES
Last Name:CALLAHAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3111 N UNIVERSITY DR
Mailing Address - Street 2:STE 429
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-5086
Mailing Address - Country:US
Mailing Address - Phone:954-757-1400
Mailing Address - Fax:954-757-3232
Practice Address - Street 1:3111 N UNIVERSITY DR
Practice Address - Street 2:STE 429
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-5086
Practice Address - Country:US
Practice Address - Phone:954-757-1400
Practice Address - Fax:954-757-3232
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0004929103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist