Basic Information
| Provider Information | |||||||||
| NPI: | 1699376103 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KELLMAN | ||||||||
| FirstName: | VICTORIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12 METHUEN ST STE 3 | ||||||||
| Address2: | |||||||||
| City: | LAWRENCE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018401772 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9786201728 | ||||||||
| FaxNumber: | 9786201794 | ||||||||
| Practice Location | |||||||||
| Address1: | 12 METHUEN ST STE 3 | ||||||||
| Address2: | |||||||||
| City: | LAWRENCE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018401772 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9786201728 | ||||||||
| FaxNumber: | 9786201794 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2020 | ||||||||
| LastUpdateDate: | 11/03/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.