Healthcare Provider Details

I. General information

NPI: 1114062239
Provider Name (Legal Business Name): PAUL JOHN CALLAHAN PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2557 MASSACHUSETTS AVE
CAMBRIDGE MA
02140-1020
US

IV. Provider business mailing address

26 STEVENS TER
ARLINGTON MA
02476-7720
US

V. Phone/Fax

Practice location:
  • Phone: 781-643-1020
  • Fax:
Mailing address:
  • Phone: 781-643-1531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number6376
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: