MEDICARE: BAT-AMI KLEJNER MFT

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	106H00000X	Marriage & Family Therapist	MFC 40774	CA

General Provider Information

NPI Number	:	1710049846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BAT-AMI KLEJNER MFT

Provider Business Mailing Address
First Line	:	61 RENATO CT
Second Line	:	SUITE 10
City	:	REDWOOD CITY
State	:	CA
Zip	:	94061-4093
Country	:	US
Telephone Number	:	650-266-9265
Fax Number	:

Provider Business Practice Location Address
First Line	:	61 RENATO CT
Second Line	:	SUITE 16
City	:	REDWOOD CITY
State	:	CA
Zip	:	94061-4093
Country	:	US
Telephone Number	:	650-266-9265
Fax Number	:

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

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	07/08/2007

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