Healthcare Provider Details

I. General information

NPI: 1427482561
Provider Name (Legal Business Name): AMY S KLEINSMITH MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2013
Last Update Date: 08/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 WINDSOR AVE SECOND FLOOR
MERIDEN CT
06451-2900
US

IV. Provider business mailing address

164 VERNON AVE #24
VERNON CT
06066-4329
US

V. Phone/Fax

Practice location:
  • Phone: 860-518-5557
  • Fax:
Mailing address:
  • Phone: 484-336-7363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number10811
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: