Healthcare Provider Details

I. General information

NPI: 1366604498
Provider Name (Legal Business Name): DALE ROBIN KLEIN-KENNEDY M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DALE ROBIN KLEIN M.A.

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10709 CIELO VISTA DEL NORTE
CORRALES NM
87048-8905
US

IV. Provider business mailing address

10709 CIELO VISTA DEL NORTE
CORRALES NM
87048-8905
US

V. Phone/Fax

Practice location:
  • Phone: 505-350-4237
  • Fax: 505-843-9520
Mailing address:
  • Phone: 505-350-4237
  • Fax: 505-843-9520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0074381
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: