Individual
CHARLES B. KELLAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW-R
Contact information
Practice address
1727 AMSTERDAM AVE, NEW YORK, NY 10031-4611
(212) 694-9200
(212) 368-5608
Mailing address
30 PARK TER E APT 5E, NEW YORK, NY 10034-1559
(212) 304-0583
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
047627-1
NY
Other
Enumeration date
11/29/2006
Last updated
07/08/2007
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