Provider Demographics
NPI:1316420714
Name:CALLAHAN, CHRISTOPHER GERALD (LCSW, CASAC)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:GERALD
Last Name:CALLAHAN
Suffix:
Gender:M
Credentials:LCSW, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 SAGAMORE HILLS DR UNIT 240
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-3528
Mailing Address - Country:US
Mailing Address - Phone:631-379-3137
Mailing Address - Fax:
Practice Address - Street 1:1000 MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-2250
Practice Address - Country:US
Practice Address - Phone:631-743-5659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-11
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0961081041C0700X
NY30721101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY30721OtherCASAC
NY096108OtherLCSW