Provider Demographics
NPI:1912151556
Name:CALLENDER, LATEISHA MASON (PHD)
Entity Type:Individual
Prefix:
First Name:LATEISHA
Middle Name:MASON
Last Name:CALLENDER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-2312
Mailing Address - Country:US
Mailing Address - Phone:908-725-8880
Mailing Address - Fax:908-725-5656
Practice Address - Street 1:62 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-2312
Practice Address - Country:US
Practice Address - Phone:908-725-8880
Practice Address - Fax:908-725-5656
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-10
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00450000103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist