Healthcare Provider Details

I. General information

NPI: 1720868524
Provider Name (Legal Business Name): MEREDITH KELLMAN, LCSW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2023
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 AYERS CT APT C2
TEANECK NJ
07666-5153
US

IV. Provider business mailing address

2110 TOWN CENTER WAY # 1129
LIVINGSTON NJ
07039-2978
US

V. Phone/Fax

Practice location:
  • Phone: 201-613-2442
  • Fax:
Mailing address:
  • Phone: 201-613-2442
  • Fax: 201-613-2388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MEREDITH A KELLMAN
Title or Position: OWNER
Credential: LCSW
Phone: 201-613-2442