1598852212 NPI number — MRS. KATHERINE LEONARD CALLAHAN LCSW-C

Table of content: MRS. KATHERINE LEONARD CALLAHAN LCSW-C (NPI 1598852212)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598852212 NPI number — MRS. KATHERINE LEONARD CALLAHAN LCSW-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CALLAHAN
Provider First Name:
KATHERINE
Provider Middle Name:
LEONARD
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CALLAHAN
Provider Other First Name:
KATHY
Provider Other Middle Name:
LEONARD
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1598852212
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/06/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29315 ERICKSON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EASTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21601-8651
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-690-8181
Provider Business Mailing Address Fax Number:
410-690-8185

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8614 OCEAN GTWY
Provider Second Line Business Practice Location Address:
STE 4
Provider Business Practice Location Address City Name:
EASTON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21601-7217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-690-8181
Provider Business Practice Location Address Fax Number:
410-690-8181
Provider Enumeration Date:
10/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  07050 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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