Provider Demographics
NPI:1629316229
Name:KELLERMAN, CAROL LEE (MS)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:LEE
Last Name:KELLERMAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 CYNTHIA DR
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-4918
Mailing Address - Country:US
Mailing Address - Phone:516-633-2368
Mailing Address - Fax:516-414-0164
Practice Address - Street 1:714 CYNTHIA DR
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-4918
Practice Address - Country:US
Practice Address - Phone:516-633-2368
Practice Address - Fax:516-414-0164
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator