Provider Demographics
NPI:1033545389
Name:KELLERMAN, PHOEBE C (LISW)
Entity Type:Individual
Prefix:
First Name:PHOEBE
Middle Name:C
Last Name:KELLERMAN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4625 MORSE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-8355
Mailing Address - Country:US
Mailing Address - Phone:614-478-3131
Mailing Address - Fax:888-545-1619
Practice Address - Street 1:4625 MORSE RD STE 201
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-8355
Practice Address - Country:US
Practice Address - Phone:614-478-3131
Practice Address - Fax:888-545-1619
Is Sole Proprietor?:No
Enumeration Date:2013-09-18
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
I1303084104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker