MEDICARE: CHARLES V CALLAHAN PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TB0200X	Cognitive & Behavioral Psychologist	004169-1	NY

General Provider Information

NPI Number	:	1497823553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES V CALLAHAN PH.D.

Provider Business Mailing Address
First Line	:	287 MAPLE ST
Second Line	:
City	:	WEST HEMPSTEAD
State	:	NY
Zip	:	11552-3203
Country	:	US
Telephone Number	:	516-485-5481
Fax Number	:	516-485-5481

Provider Business Practice Location Address
First Line	:	287 MAPLE ST
Second Line	:
City	:	WEST HEMPSTEAD
State	:	NY
Zip	:	11552-3203
Country	:	US
Telephone Number	:	516-485-5481
Fax Number	:	516-485-5481

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	05/30/2008

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