Individual
DR. IDA KELLISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
150 S HUNTINGTON AVE, VA BOSTON HEALTHCARE SYSTEM, PSYCHOLOGY, 116B, BOSTON, MA 02130-4817
(857) 364-6204
Mailing address
150 S HUNTINGTON AVE, VA BOSTON HEALTHCARE SYSTEM, PSYCHOLOGY, 116B, BOSTON, MA 02130-4817
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
9512
MA
103TC0700X
Clinical Psychologist
9512
MA
Other
Enumeration date
04/30/2012
Last updated
04/30/2012
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