MEDICARE: MRS. SUSAN MANIS CALLEN LCSW,LMFT

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	1041C0700X	Clinical Social Worker	552	KY

General Provider Information

NPI Number	:	1851409585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN MANIS CALLEN LCSW,LMFT

Provider Business Mailing Address
First Line	:	5107 LONG KNIFE RUN
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-1179
Country	:	US
Telephone Number	:	502-895-5255
Fax Number	:	502-893-9031

Provider Business Practice Location Address
First Line	:	2327 LIME KILN LN
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40222-3422
Country	:	US
Telephone Number	:	502-429-0081
Fax Number	:

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

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	07/08/2007

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