Provider Demographics
NPI:1154358349
Name:CALLAN, JOSEPH P (LCSW)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:P
Last Name:CALLAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11700 N 58TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-1692
Mailing Address - Country:US
Mailing Address - Phone:813-980-3488
Mailing Address - Fax:813-980-3647
Practice Address - Street 1:11700 N 58TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-1692
Practice Address - Country:US
Practice Address - Phone:813-980-3488
Practice Address - Fax:813-980-3647
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 17851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ4276Medicare ID - Type Unspecified