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Individual
DR. DOMINIK LIA KELLER
Active
Individual
DR. DOMINIK LIA KELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
621149
MS
106S00000X
Behavior Technician
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110026265E
—
MA
05
—
200000200
—
MS
Enumeration date
03/29/2022
Last updated
12/15/2022
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