Healthcare Provider Details

I. General information

NPI: 1437651627
Provider Name (Legal Business Name): NICHOLAS BARRY KLEIN LADC, LP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2018
Last Update Date: 01/22/2026
Certification Date: 01/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

U.S. NAVY MEDICINE READININESS AND TRAINING COMMAND FAMILY MEDICINE DEPARTMENT
FPO AP
96350-9998
US

IV. Provider business mailing address

PSC 475 BOX 1478
FPO AP
96350-1478
US

V. Phone/Fax

Practice location:
  • Phone: 315-243-8721
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number302751
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP6676
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: