Provider Demographics
NPI:1194784827
Name:CALLARD, JOHANNA (LCSW)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:
Last Name:CALLARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 JAMAICA ST
Mailing Address - Street 2:#3
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130
Mailing Address - Country:US
Mailing Address - Phone:617-272-5292
Mailing Address - Fax:
Practice Address - Street 1:5 SACRAMENTO ST
Practice Address - Street 2:THE GUIDANCE CENTER INC
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138
Practice Address - Country:US
Practice Address - Phone:617-354-2275
Practice Address - Fax:617-547-4356
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA213529104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker