Healthcare Provider Details

I. General information

NPI: 1548325632
Provider Name (Legal Business Name): RUTH KLEIN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5251 EMERSON ST
JACKSONVILLE FL
32207-4932
US

IV. Provider business mailing address

2740 BEAUCLERC RD
JACKSONVILLE FL
32257-5602
US

V. Phone/Fax

Practice location:
  • Phone: 904-399-0324
  • Fax:
Mailing address:
  • Phone: 904-733-7722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH937
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSS186
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: