Healthcare Provider Details

I. General information

NPI: 1194784827
Provider Name (Legal Business Name): JOHANNA CALLARD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 SACRAMENTO ST THE GUIDANCE CENTER INC
CAMBRIDGE MA
02138
US

IV. Provider business mailing address

62 JAMAICA ST #3
JAMAICA PLAIN MA
02130
US

V. Phone/Fax

Practice location:
  • Phone: 617-354-2275
  • Fax: 617-547-4356
Mailing address:
  • Phone: 617-272-5292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number213529
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: