Healthcare Provider Details

I. General information

NPI: 1851566921
Provider Name (Legal Business Name): MEREDITH A KELLMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MEREDITH A RUSS LCSW

II. Dates (important events)

Enumeration Date: 04/29/2008
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: 201-613-2388
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 Number44SC05357200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: