MEDICARE: BRUNA MARTINS KLEIN PH.D

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	103TA0700X	Adult Development & Aging Psychologist	11329	MA
2	103TP2701X	Group Psychotherapy Psychologist	11329	MA
3	103TC0700X	Clinical Psychologist	11329	MA

General Provider Information

NPI Number	:	1740879642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRUNA MARTINS KLEIN PH.D

Provider Business Mailing Address
First Line	:	23 LEXINGTON AVE APT B
Second Line	:
City	:	FLORENCE
State	:	MA
Zip	:	01062-2711
Country	:	US
Telephone Number	:	503-200-0676
Fax Number	:

Provider Business Practice Location Address
First Line	:	23 LEXINGTON AVE APT B
Second Line	:
City	:	FLORENCE
State	:	MA
Zip	:	01062-2711
Country	:	US
Telephone Number	:	503-200-0676
Fax Number	:

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

Provider Enumeration Date	:	01/14/2021
Last Update Date	:	01/14/2021

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