Provider Demographics
NPI:1740457993
Name:CALLAN, CRAIG MATTHEW (PSYD)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:MATTHEW
Last Name:CALLAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 N 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-2419
Mailing Address - Country:US
Mailing Address - Phone:732-735-6444
Mailing Address - Fax:
Practice Address - Street 1:10 N 2ND AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-2419
Practice Address - Country:US
Practice Address - Phone:732-735-6444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00452100103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical