Healthcare Provider Details

I. General information

NPI: 1316099591
Provider Name (Legal Business Name): STEPHANIE NICOLE KLEINBERG LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE FELDMAN

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 WEST 34TH STREET PH
NEW YORK CITY NY
10001
US

IV. Provider business mailing address

67 71 YELLOWSTONE BLVD APT 6B
FOREST HILLS NY
11375
US

V. Phone/Fax

Practice location:
  • Phone: 212-726-3156
  • Fax: 212-815-1268
Mailing address:
  • Phone: 646-236-4774
  • Fax: 212-815-1268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberRO50060
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: