Provider Demographics
NPI:1740332949
Name:CALLNAN, MAUREEN E (PMHNP)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:E
Last Name:CALLNAN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 BELMEADE RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-1815
Mailing Address - Country:US
Mailing Address - Phone:207-773-1966
Mailing Address - Fax:207-292-2606
Practice Address - Street 1:449 FOREST AVE STE 211
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2008
Practice Address - Country:US
Practice Address - Phone:207-773-1966
Practice Address - Fax:207-292-2606
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP111003363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MENS805902Medicare PIN
P47921Medicare UPIN
MENS805901Medicare PIN