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General NPI Number Information
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NPI Number | 1336286814
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Entity Type | Individual
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Provider Name | STACEY KLEIN LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 11/22/2022
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Provider Practice Location Address
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Address Line | 250 W 94TH ST
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City | NEW YORK
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State | NY
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Zip | 10025-6954
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Country | US
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Telephone | 646-326-5187
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Fax |
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Provider Business Mailing Address
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Address Line | 277 BALDWIN ST APT 415
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City | GLEN RIDGE
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State | NJ
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Zip | 07028-1539
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Country | US
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Telephone | 646-326-5187
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | R053171
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License Number State | NY
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