1316099591 NPI number — MRS. STEPHANIE NICOLE KLEINBERG LCSW

Table of content: MRS. STEPHANIE NICOLE KLEINBERG LCSW (NPI 1316099591)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316099591 NPI number — MRS. STEPHANIE NICOLE KLEINBERG LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KLEINBERG
Provider First Name:
STEPHANIE
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FELDMAN
Provider Other First Name:
STEPHANIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1316099591
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
67 71 YELLOWSTONE BLVD
Provider Second Line Business Mailing Address:
APT 6B
Provider Business Mailing Address City Name:
FOREST HILLS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11375
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
646-236-4774
Provider Business Mailing Address Fax Number:
212-815-1268

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19 WEST 34TH STREET
Provider Second Line Business Practice Location Address:
PH
Provider Business Practice Location Address City Name:
NEW YORK CITY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-726-3156
Provider Business Practice Location Address Fax Number:
212-815-1268
Provider Enumeration Date:
01/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  RO50060 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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