MEDICARE: FREDRIC B. KLEINER, PH.D. & ASSOCIATES, P.C.

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	00640	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639477565
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FREDRIC B. KLEINER, PH.D. & ASSOCIATES, P.C.

Provider Business Mailing Address
First Line	:	4401 E WEST HWY
Second Line	:	SUITE 307
City	:	BETHESDA
State	:	MD
Zip	:	20814-4523
Country	:	US
Telephone Number	:	301-652-2120
Fax Number	:	301-657-9224

Provider Business Practice Location Address
First Line	:	4401 E WEST HWY
Second Line	:	SUITE 307
City	:	BETHESDA
State	:	MD
Zip	:	20814-4523
Country	:	US
Telephone Number	:	301-652-2120
Fax Number	:	301-657-9224

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. FREDRIC BARRY KLEINER
Credential	:	PH.D.
Telephone Number	:	301-652-2120

Provider Enumeration Date	:	03/01/2011
Last Update Date	:	03/01/2011

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