Basic Information
| Provider Information | |||||||||
| NPI: | 1598852212 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CALLAHAN | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | LEONARD | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CALLAHAN | ||||||||
| OtherFirstName: | KATHY | ||||||||
| OtherMiddleName: | LEONARD | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MSW | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 29315 ERICKSON DR | ||||||||
| Address2: | |||||||||
| City: | EASTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 216018651 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106908181 | ||||||||
| FaxNumber: | 4106908185 | ||||||||
| Practice Location | |||||||||
| Address1: | 8614 OCEAN GTWY | ||||||||
| Address2: | STE 4 | ||||||||
| City: | EASTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 216017217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106908181 | ||||||||
| FaxNumber: | 4106908181 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2006 | ||||||||
| LastUpdateDate: | 04/06/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 04/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 07050 | MD | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 517251 | 01 | UNITED HEALTH CARE MAMSI | OTHER | 517251 | 01 | UHC MAMSI GROUP | OTHER | 609550002 | 05 | MD | MEDICAID | LM49EA | 01 | MD | CAREFIRST BCBS GROUP | OTHER | 259147000 | 01 | MD | MAGELLAN GROUP | OTHER | 522555502 | 01 | MD | CAREFIRST BCBS PIN | OTHER | 724337 | 01 | NCPPO PIN | OTHER | 003953 | 01 | VALUE OPTIONS | OTHER | 100062229001 | 01 | AMERICAN PSYCH SYSTEM | OTHER | 6296784 | 01 | UNITED BEHAVIORAL HEALTH | OTHER | R968 | 01 | DC | CAREFIRST FEDERAL GROUP | OTHER | 0012 | 01 | DC | CAREFIRST FEDERAL PIN | OTHER | 461837000 | 01 | MD | MAGELLAN PIN | OTHER |