Provider Demographics
NPI:1396499356
Name:CALLAGHAN, BRONWEN (LPC)
Entity type:Individual
Prefix:
First Name:BRONWEN
Middle Name:
Last Name:CALLAGHAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 SWEDE RD STE 212
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-3372
Mailing Address - Country:US
Mailing Address - Phone:610-304-2055
Mailing Address - Fax:
Practice Address - Street 1:1717 SWEDE RD STE 212
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-3372
Practice Address - Country:US
Practice Address - Phone:610-304-2055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-09
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC014157101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional