Provider Demographics
NPI:1275677676
Name:KELLNER, LYNNE ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:LYNNE
Middle Name:ANN
Last Name:KELLNER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 BLOSSOM ST
Mailing Address - Street 2:
Mailing Address - City:ROYALSTON
Mailing Address - State:MA
Mailing Address - Zip Code:01368-9512
Mailing Address - Country:US
Mailing Address - Phone:978-249-4644
Mailing Address - Fax:978-665-3614
Practice Address - Street 1:10 BLOSSOM ST
Practice Address - Street 2:
Practice Address - City:ROYALSTON
Practice Address - State:MA
Practice Address - Zip Code:01368-9512
Practice Address - Country:US
Practice Address - Phone:978-249-4644
Practice Address - Fax:978-665-3614
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6857103TC1900X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAKEW50175Medicare ID - Type UnspecifiedMEDICARE B PROVIDER