Provider Demographics
NPI:1225108970
Name:KELLNER, ARI JASON (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ARI
Middle Name:JASON
Last Name:KELLNER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 SMITH AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-2813
Mailing Address - Country:US
Mailing Address - Phone:914-242-2100
Mailing Address - Fax:914-242-2101
Practice Address - Street 1:49 SMITH AVE
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-2813
Practice Address - Country:US
Practice Address - Phone:914-242-2100
Practice Address - Fax:914-242-2101
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015432103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVM1231Medicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST