Provider Demographics
NPI:1881159630
Name:KELLERMAN, AMY ELIZABETH (LPC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:ELIZABETH
Last Name:KELLERMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 WATER STREET
Mailing Address - Street 2:DOWNTOWN MALL
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335
Mailing Address - Country:US
Mailing Address - Phone:814-724-4100
Mailing Address - Fax:814-333-2779
Practice Address - Street 1:920 WATER STREET
Practice Address - Street 2:DOWNTOWN MALL
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335
Practice Address - Country:US
Practice Address - Phone:814-724-4100
Practice Address - Fax:814-333-2779
Is Sole Proprietor?:No
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC010772101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional