Active NPI
Mary Ann S Callen, PSY.D.
- Psychologist
- Roanoke, VA
National Provider Identifier
1083988414
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 511
- Practice address
- 3959 Electric Rd Ste 465
Roanoke, VA 24018-4559 - Phone
- (540) 632-0847
- NPI assigned
- Mar 2, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 511 | WY | Primary |
| Clinical Psychologist | 103TC0700X | 0810007635 | VA |
Addresses
Primary practice location
3959 Electric Rd Ste 465
Roanoke, VA 24018-4559
Mailing address
5490 The Peaks Dr
Roanoke, VA 24018-1104
Phone (610) 547-0347
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0810007635 | VA | MD | Clinical Psychologist |
| 511 | WY | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1330646400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1676419200000",
"number": "1083988414",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5490 THE PEAKS DR",
"city": "ROANOKE",
"state": "VA",
"postal_code": "240181104",
"telephone_number": "610-547-0347"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3959 ELECTRIC RD STE 465",
"city": "ROANOKE",
"state": "VA",
"postal_code": "240184559",
"telephone_number": "540-632-0847"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CALLEN",
"first_name": "MARY ANN",
"middle_name": "S",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-03-02",
"last_updated": "2023-02-15",
"certification_date": "2023-02-15",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "WY",
"license": "511",
"primary": true
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "VA",
"license": "0810007635",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roanoke, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.