Provider Demographics
NPI:1780453209
Name:KELLMAN, TARA VICTORIA (PSYD)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:VICTORIA
Last Name:KELLMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 OGDEN AVE # 2
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307-1203
Mailing Address - Country:US
Mailing Address - Phone:347-852-5978
Mailing Address - Fax:
Practice Address - Street 1:1430 BROADWAY RM 1102
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-9201
Practice Address - Country:US
Practice Address - Phone:347-201-2099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-26
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist