Provider Demographics
NPI:1851566921
Name:KELLMAN, MEREDITH A (LCSW)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:A
Last Name:KELLMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:A
Other - Last Name:RUSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1775 WINDSOR RD APT 293
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3071
Mailing Address - Country:US
Mailing Address - Phone:201-613-2442
Mailing Address - Fax:201-613-2388
Practice Address - Street 1:1775 WINDSOR RD APT 293
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-3071
Practice Address - Country:US
Practice Address - Phone:201-613-2442
Practice Address - Fax:201-613-2388
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC053572001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical