Healthcare Provider Details

I. General information

NPI: 1699902064
Provider Name (Legal Business Name): MATTHEW KLEIMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2009
Last Update Date: 06/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 BROOKELY AVE BOLLING AFB
WASHINGTON DC
20032
US

IV. Provider business mailing address

1120 VERMONT AVE NW
WASHINGTON DC
20005-3523
US

V. Phone/Fax

Practice location:
  • Phone: 202-767-0611
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number002681
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: