Provider Demographics
NPI:1619039609
Name:KELLAR, LUCIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:LUCIA
Middle Name:
Last Name:KELLAR
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 1:405 W 23RD ST
Mailing Address - Street 2:6E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-1404
Mailing Address - Country:US
Mailing Address - Phone:212-366-5015
Mailing Address - Fax:
Practice Address - Street 1:405 W 23RD ST
Practice Address - Street 2:6E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-1404
Practice Address - Country:US
Practice Address - Phone:212-366-5015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006000103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0080961OtherGHI
NY137035OtherVALUE OPTIONS
NYR51133Medicare UPIN
NYV13971Medicare ID - Type Unspecified