Provider Demographics
NPI:1447621586
Name:CALLAHAN, TIMOTHY (MED,LPC)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:CALLAHAN
Suffix:
Gender:M
Credentials:MED,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2630 E CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08361-8400
Mailing Address - Country:US
Mailing Address - Phone:856-696-5690
Mailing Address - Fax:856-696-4799
Practice Address - Street 1:2630 E CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08361-8400
Practice Address - Country:US
Practice Address - Phone:856-696-5690
Practice Address - Fax:856-696-4799
Is Sole Proprietor?:No
Enumeration Date:2015-10-15
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00526900101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional