MEDICARE: STEFANIE JILL KLEIN LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	19450	CA

General Provider Information

NPI Number	:	1215059357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEFANIE JILL KLEIN LCSW

Provider Business Mailing Address
First Line	:	1554 S SEPULVEDA BLVD
Second Line	:	#106
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-3377
Country	:	US
Telephone Number	:	310-204-5550
Fax Number	:

Provider Business Practice Location Address
First Line	:	1554 S SEPULVEDA BLVD
Second Line	:	#106
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-3377
Country	:	US
Telephone Number	:	310-204-5550
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2007
Last Update Date	:	07/10/2007

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