MEDICARE: MRS. STEPHANIE NICOLE KLEINBERG LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	RO50060	NY

General Provider Information

NPI Number	:	1316099591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEPHANIE NICOLE KLEINBERG LCSW

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

Provider Business Practice Location Address
First Line	:	19 WEST 34TH STREET
Second Line	:	PH
City	:	NEW YORK CITY
State	:	NY
Zip	:	10001
Country	:	US
Telephone Number	:	212-726-3156
Fax Number	:	212-815-1268

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	07/08/2007

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