Healthcare Provider Details

I. General information

NPI: 1760477988
Provider Name (Legal Business Name): ROBERT L KLEIN PH D
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 HOLLYHOCK DR
LAFAYETTE HILL PA
19444-2105
US

IV. Provider business mailing address

105 HOLLYHOCK DR
LAFAYETTE HILL PA
19444-2105
US

V. Phone/Fax

Practice location:
  • Phone: 610-825-2839
  • Fax: 610-825-9056
Mailing address:
  • Phone: 610-825-2839
  • Fax: 610-825-9056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS001114L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: