Healthcare Provider Details

I. General information

NPI: 1730540337
Provider Name (Legal Business Name): GINA O'CALLAGHAN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2016
Last Update Date: 07/21/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BUILDING 1 AVE C
PERRY POINT MD
21902
US

IV. Provider business mailing address

27 HUNT VALLEY LOOP
ELKTON MD
21921-1941
US

V. Phone/Fax

Practice location:
  • Phone: 410-658-0100
  • Fax: 410-658-0199
Mailing address:
  • Phone: 410-441-0781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA3830
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: