Healthcare Provider Details

I. General information

NPI: 1740879642
Provider Name (Legal Business Name): BRUNA MARTINS KLEIN PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BRUNA SUEMI MARTINS PH.D

II. Dates (important events)

Enumeration Date: 01/14/2021
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 LEXINGTON AVE APT B
FLORENCE MA
01062-2711
US

IV. Provider business mailing address

23 LEXINGTON AVE APT B
FLORENCE MA
01062-2711
US

V. Phone/Fax

Practice location:
  • Phone: 503-200-0676
  • Fax:
Mailing address:
  • Phone: 503-200-0676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number11329
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number11329
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number11329
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: