Provider Demographics
NPI:1316421563
Name:GONSALVES MCCALLUM, ANDREA THERESA (LICSW)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:THERESA
Last Name:GONSALVES MCCALLUM
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 SANDRA RD
Mailing Address - Street 2:
Mailing Address - City:EASTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01027-2514
Mailing Address - Country:US
Mailing Address - Phone:413-626-8540
Mailing Address - Fax:413-529-1594
Practice Address - Street 1:9 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:EASTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01027-1415
Practice Address - Country:US
Practice Address - Phone:413-626-8540
Practice Address - Fax:413-529-1594
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-23
Last Update Date:2018-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1027367-SW-LICSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical