Provider Demographics
NPI:1215505862
Name:CALLAWAY, ALYSSA (MS)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:CALLAWAY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 W ATHENS AVE
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19003-1308
Mailing Address - Country:US
Mailing Address - Phone:215-962-9061
Mailing Address - Fax:
Practice Address - Street 1:115 CYNWYD RD
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-3022
Practice Address - Country:US
Practice Address - Phone:215-645-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-10
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF001393106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist