Provider Demographics
NPI:1154822732
Name:KELLERMAN, CELIA (MSED, BCBA, LBA)
Entity type:Individual
Prefix:MRS
First Name:CELIA
Middle Name:
Last Name:KELLERMAN
Suffix:
Gender:F
Credentials:MSED, BCBA, LBA
Other - Prefix:
Other - First Name:CELIA
Other - Middle Name:
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30 FULTON DR
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-7827
Mailing Address - Country:US
Mailing Address - Phone:703-973-3479
Mailing Address - Fax:
Practice Address - Street 1:30 FULTON DR
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-7827
Practice Address - Country:US
Practice Address - Phone:703-973-3479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-28
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133000603103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst