Provider Demographics
NPI:1669508933
Name:KELLERMAN, HENRY (PHD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:
Last Name:KELLERMAN
Suffix:
Gender:M
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 GRAMERCY PARK S
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-1707
Mailing Address - Country:US
Mailing Address - Phone:212-982-0317
Mailing Address - Fax:
Practice Address - Street 1:32 GRAMERCY PARK S
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-1707
Practice Address - Country:US
Practice Address - Phone:212-982-0317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0030591103TC0700X
NY103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0030591OtherLIC #
NY0030591OtherLIC #