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General NPI Number Information
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NPI Number | 1760949929
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Entity Type | Individual
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Provider Name | SUSAN CALLAHAN
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Gender | Female
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Dates
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Enumeration Date | 02/25/2019
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Last Update Date | 02/25/2019
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Provider Practice Location Address
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Address Line | 298 FEDERAL ST # CONDOB3
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City | GREENFIELD
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State | MA
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Zip | 01301-1932
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Country | US
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Telephone | 413-772-0249
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Fax |
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Provider Business Mailing Address
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Address Line | 298 FEDERAL ST # CONDOB3
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City | GREENFIELD
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State | MA
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Zip | 01301-1932
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Country | US
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Telephone | 413-772-0249
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0807X
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Taxonomy Name | Child & Adolescent Psychiatric/Mental Health Registered Nurse
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License Number | 160222
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License Number State | MA
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