Healthcare Provider Details

I. General information

NPI: 1639700651
Provider Name (Legal Business Name): MELISSA B CALLAHAM LCSW PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2020
Last Update Date: 07/28/2020
Certification Date: 07/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 SE OCEAN BLVD STE D130
STUART FL
34994-3503
US

IV. Provider business mailing address

900 SE OCEAN BLVD STE D130
STUART FL
34994-3503
US

V. Phone/Fax

Practice location:
  • Phone: 772-204-5260
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MELISSA B CALLAHAM
Title or Position: OWNER/PROVIDER
Credential: LCSW
Phone: 772-204-5260