Provider Demographics
NPI:1558513721
Name:MELAND-LEWIS, KELLI ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:KELLI
Middle Name:ANN
Last Name:MELAND-LEWIS
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 1:32 SCHREMPP LN
Mailing Address - Street 2:
Mailing Address - City:PINE BUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12566-5735
Mailing Address - Country:US
Mailing Address - Phone:845-744-5480
Mailing Address - Fax:
Practice Address - Street 1:32 SCHREMPP LN
Practice Address - Street 2:
Practice Address - City:PINE BUSH
Practice Address - State:NY
Practice Address - Zip Code:12566-5735
Practice Address - Country:US
Practice Address - Phone:845-744-5480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-18
Last Update Date:2008-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017814103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical