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NPI Code Detail

MEDICARE: SUSAN CALLAHAN MSW, LICSW

MEDICARE: SUSAN CALLAHAN MSW, LICSW
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
11041C0700XClinical Social WorkerDP00945105WV

General Provider Information

NPI Number : 1932779683
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN CALLAHAN MSW, LICSW
Provider Business Mailing Address
First Line : PO BOX 1074
Second Line :
City : MARTINSBURG
State : WV
Zip : 25402-1074
Country : US
Telephone Number : 304-886-4118
Fax Number :
Provider Business Practice Location Address
First Line : 1020 WINCHESTER AVE
Second Line :
City : MARTINSBURG
State : WV
Zip : 25401-1650
Country : US
Telephone Number : 304-886-4118
Fax Number : 304-579-8606
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2021
Last Update Date : 06/25/2021

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