=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417223462
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREA LEE CALLAHAN MSHS- COMMUNITY PSYC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/23/2012
-----------------------------------------------------
Last Update Date | 03/23/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 131 WEST MAIN STREET CHD-FIRST FLOOR
-----------------------------------------------------
City | ORANGE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01364
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-544-2148
-----------------------------------------------------
Fax | 978-544-2196
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 131 WEST MAIN STREET CHD-FIRST FLOOR
-----------------------------------------------------
City | ORANGE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01364
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-544-2148
-----------------------------------------------------
Fax | 978-544-2196
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------