=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801166269
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR HARVEY A KLEIN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2012
-----------------------------------------------------
Last Update Date | 01/03/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12788 FOREST HILL BLVD SUITE 1002
-----------------------------------------------------
City | WELLINGTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33414-4703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-793-4400
-----------------------------------------------------
Fax | 561-798-5571
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12788 FOREST HILL BLVD SUITE 1002
-----------------------------------------------------
City | WELLINGTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33414-4703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-793-4400
-----------------------------------------------------
Fax | 561-798-5571
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MARILYN KLEIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 561-793-5087
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | PY3168
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------