Provider Demographics
NPI:1023522521
Name:KELBERMAN CENTER, INC
Entity type:Organization
Organization Name:KELBERMAN CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH MANAGEMENT SYSTEMS SPECIALIS
Authorized Official - Prefix:
Authorized Official - First Name:MARYANN
Authorized Official - Middle Name:
Authorized Official - Last Name:FATATA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-927-2117
Mailing Address - Street 1:2608 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-6003
Mailing Address - Country:US
Mailing Address - Phone:315-797-6241
Mailing Address - Fax:315-794-7054
Practice Address - Street 1:2608 GENESEE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-6003
Practice Address - Country:US
Practice Address - Phone:315-797-6421
Practice Address - Fax:315-749-7054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-21
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04587431Medicaid