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General NPI Number Information
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NPI Number | 1417491242
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Entity Type | Organization
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Legal Business Name | L.J KLEIN LCSW PC
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Dates
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Enumeration Date | 12/13/2016
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Last Update Date | 12/16/2016
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Provider Practice Location Address
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Address Line | 3051 36TH ST FL 1
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City | ASTORIA
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State | NY
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Zip | 11103-4704
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Country | US
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Telephone | 718-223-0384
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Fax |
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Provider Business Mailing Address
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Address Line | 2234 77TH ST APT B1
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City | EAST ELMHURST
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State | NY
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Zip | 11370-1246
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Country | US
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Telephone | 917-378-4799
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LEONARDO J KLEIN
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Credential | LCSW
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Telephone | 718-223-0384
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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 | 082686
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License Number State | NY
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