Provider Demographics
NPI:1215114566
Name:CALLAN, KATHLEEN J
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:J
Last Name:CALLAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BETHANY RD
Mailing Address - Street 2:BUILDING 3 SUITE 42
Mailing Address - City:HAZLET
Mailing Address - State:NJ
Mailing Address - Zip Code:07730-1663
Mailing Address - Country:US
Mailing Address - Phone:732-264-4111
Mailing Address - Fax:732-886-5141
Practice Address - Street 1:3512 ROUTE 9 S
Practice Address - Street 2:SUITE 202
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-3345
Practice Address - Country:US
Practice Address - Phone:732-886-5188
Practice Address - Fax:732-886-5141
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor