Basic Information
| Provider Information | |||||||||
| NPI: | 1467961243 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CALLAHAN | ||||||||
| FirstName: | CRISTINA | ||||||||
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| Credential: | PSY.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2900 CORPORATE WAY | ||||||||
| Address2: | DOOR D | ||||||||
| City: | MIRAMAR | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330253925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9542765685 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1150 NORTH 35TH AVENUE | ||||||||
| Address2: | SUITE 520 | ||||||||
| City: | HOLLYWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9542659500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PSY9960 | FL | N | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TH0004X | PSY9960 | FL | N | Behavioral Health & Social Service Providers | Psychologist | Health | 103T00000X | PSY9960 | FL | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.