Provider Demographics
NPI:1306067095
Name:KELLMER, JUDITH M (PHD)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:M
Last Name:KELLMER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 ARROWHEAD CIRCLE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01721
Mailing Address - Country:US
Mailing Address - Phone:508-596-9903
Mailing Address - Fax:508-202-9246
Practice Address - Street 1:166 ARROWHEAD CIRCLE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:MA
Practice Address - Zip Code:01721
Practice Address - Country:US
Practice Address - Phone:508-596-9903
Practice Address - Fax:508-202-9246
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2453103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW02619OtherBLUECROSS BLUE SHIELD ID