Provider Demographics
NPI:1700959921
Name:CALLAHAN, JOHN JOSEPH (LCSW-R)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:JOSEPH
Last Name:CALLAHAN
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 ROUTE 17M
Mailing Address - Street 2:SUITE 8
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-5235
Mailing Address - Country:US
Mailing Address - Phone:845-798-3969
Mailing Address - Fax:845-615-1318
Practice Address - Street 1:2002 ROUTE 17M
Practice Address - Street 2:SUITE 8
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-5235
Practice Address - Country:US
Practice Address - Phone:845-798-3969
Practice Address - Fax:845-615-1318
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0297981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical