Healthcare Provider Details

I. General information

NPI: 1326550047
Provider Name (Legal Business Name): MAUREEN A CALLAHAN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2017
Last Update Date: 11/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47601 GRAND RIVER AVE
NOVI MI
48374-1233
US

IV. Provider business mailing address

3357 NICOLETTE DR
HOWELL MI
48843-7879
US

V. Phone/Fax

Practice location:
  • Phone: 248-465-4100
  • Fax:
Mailing address:
  • Phone: 734-546-4405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801058839
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: