=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538395470
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARTIN H. KLEIN, PH.D.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2009
-----------------------------------------------------
Last Update Date | 06/05/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21 RICE TER SUITE 313
-----------------------------------------------------
City | BRANFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06405-3853
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-481-4000
-----------------------------------------------------
Fax | 203-481-4000
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3 SHORT BEACH RD
-----------------------------------------------------
City | EAST HAVEN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06512-3520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-481-4000
-----------------------------------------------------
Fax | 203-481-4000
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL PSYCHOLOGIST
-----------------------------------------------------
Name | DR. MARTIN HAROLD KLEIN
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 203-481-4000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 001909
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------