Provider Demographics
NPI:1992725550
Name:CALLAHAN, MARY S (LICSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:S
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:115 MAIN ST STE 2D
Mailing Address - Street 2:
Mailing Address - City:NORTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02356-1469
Mailing Address - Country:US
Mailing Address - Phone:508-238-7799
Mailing Address - Fax:508-230-5089
Practice Address - Street 1:115 MAIN ST STE 2D
Practice Address - Street 2:
Practice Address - City:NORTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02356-1469
Practice Address - Country:US
Practice Address - Phone:508-238-7799
Practice Address - Fax:508-230-5089
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1067021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA468753OtherTUFTS HEALTH PLAN
MA2193145OtherCIGNA BEHAVIORAL HEALTH
MAP05783OtherBC BS OF MASSACHUSETTS
MA468753OtherTUFTS HEALTH PLAN