Provider Demographics
NPI:1366080624
Name:CALAHAN, JENNIFER (NCC, LPCMH)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:CALAHAN
Suffix:
Gender:F
Credentials:NCC, LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 JERSEY CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-6813
Mailing Address - Country:US
Mailing Address - Phone:609-330-9044
Mailing Address - Fax:
Practice Address - Street 1:10 JERSEY CT
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-6813
Practice Address - Country:US
Practice Address - Phone:609-330-9044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000975101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health