Provider Demographics
NPI:1649701061
Name:CALLAHAN, ERICA JEAN (LMSW)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:JEAN
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 WEST CHESTNUT STREET
Mailing Address - Street 2:SOUTH BAY COMMUNITY SERVICES,
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301
Mailing Address - Country:US
Mailing Address - Phone:860-578-1300
Mailing Address - Fax:860-951-7729
Practice Address - Street 1:237 HAMILTON ST. SUITE 205
Practice Address - Street 2:SOUTH BAY EARLY CHILDHOOD,
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106
Practice Address - Country:US
Practice Address - Phone:860-578-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT4743104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program