Basic Information
| Provider Information | |||||||||
| NPI: | 1992295356 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KELLAR | ||||||||
| FirstName: | SEAN-NICOLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7060 NW TURTLE WALK | ||||||||
| Address2: | |||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334872365 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5167617432 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1239 E NEWPORT CENTER DR STE 101 | ||||||||
| Address2: | |||||||||
| City: | DEERFIELD BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334427711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7544443707 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2018 | ||||||||
| LastUpdateDate: | 12/06/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | N | 103K00000X | 1-20-43251 | NY | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.