Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1041C0700X | Clinical Social Worker | 216706 | MA |
Y | 1041C0700X | Clinical Social Worker | SW11172 | FL |
NPI | 1003106311 |
---|---|
Provider Name | Mrs. Amanda Kay Callahan |
First Address | Jacksonville, FL 32207-8030 |
Second Address | Jacksonville, FL 32207-8030 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2011 |
Last Update Date | 05/05/2015 |