Provider Demographics
NPI:1699547653
Name:KELLNER-SCHOELLES, LORI JEAN LOVE (PHD)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:JEAN LOVE
Last Name:KELLNER-SCHOELLES
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 1:8455 CHESTNUT RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GASPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14067-9347
Mailing Address - Country:US
Mailing Address - Phone:716-863-4632
Mailing Address - Fax:
Practice Address - Street 1:8455 CHESTNUT RIDGE RD
Practice Address - Street 2:
Practice Address - City:GASPORT
Practice Address - State:NY
Practice Address - Zip Code:14067-9347
Practice Address - Country:US
Practice Address - Phone:716-863-4632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024023103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical