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General NPI Number Information
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NPI Number | 1962410860
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Entity Type | Individual
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Provider Name | THERESA A CALLENDER LCSW, PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/04/2006
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Last Update Date | 01/30/2020
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Provider Practice Location Address
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Address Line | 11 MEDICAL CENTER DR
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City | BRUNSWICK
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State | ME
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Zip | 04011-3061
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Country | US
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Telephone | 207-373-9417
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Fax |
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Provider Business Mailing Address
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Address Line | 11 MEDICAL CENTER DR
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City | BRUNSWICK
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State | ME
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Zip | 04011-3061
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Country | US
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Telephone | 941-320-5454
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW10945
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA2013
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License Number State | ME
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