1174009427 NPI number — MR. VINCENT LAWRENCE CALLOWAY MSS, LCSW, CEAP

Table of content: MR. VINCENT LAWRENCE CALLOWAY MSS, LCSW, CEAP (NPI 1174009427)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174009427 NPI number — MR. VINCENT LAWRENCE CALLOWAY MSS, LCSW, CEAP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CALLOWAY
Provider First Name:
VINCENT
Provider Middle Name:
LAWRENCE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MSS, LCSW, CEAP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174009427
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
02/25/2020
NPI Reactivation Date:
02/27/2020

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1989 N. 63RD ST., SUITE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19151
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1989 N 63RD ST STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19151-2607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-878-1258
Provider Business Practice Location Address Fax Number:
215-878-8998
Provider Enumeration Date:
07/18/2018

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:  CW019505 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com