Healthcare Provider Details

I. General information

NPI: 1497896476
Provider Name (Legal Business Name): CYNTHIA RENEE CALLAGHAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2007
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 N PLEASANT AVE
FRESNO CA
93728-2434
US

IV. Provider business mailing address

1040 N PLEASANT AVE
FRESNO CA
93728-2434
US

V. Phone/Fax

Practice location:
  • Phone: 559-930-9327
  • Fax: 559-000-0000
Mailing address:
  • Phone: 559-930-9327
  • Fax: 559-000-0000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17189
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: