Provider Demographics
NPI:1215249925
Name:CALLEN, LYNNE MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:LYNNE
Middle Name:MARIE
Last Name:CALLEN
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 1:2400 HALE DRIVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010
Mailing Address - Country:US
Mailing Address - Phone:650-344-1223
Mailing Address - Fax:
Practice Address - Street 1:4501 BROADWAY
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-4615
Practice Address - Country:US
Practice Address - Phone:510-752-2755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-10
Last Update Date:2010-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS156441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical