Provider Demographics
NPI:1114086782
Name:KLEINMAN, EDYTHE R (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:EDYTHE
Middle Name:R
Last Name:KLEINMAN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:EDYTHE
Other - Middle Name:R
Other - Last Name:PINCHUK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCPC
Mailing Address - Street 1:3125 TOULON DR
Mailing Address - Street 2:UNIT B1
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062
Mailing Address - Country:US
Mailing Address - Phone:847-272-7379
Mailing Address - Fax:
Practice Address - Street 1:3255 N ARLINGTON HEIGHTS RD
Practice Address - Street 2:SUITE 502
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004
Practice Address - Country:US
Practice Address - Phone:847-272-7379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1635347OtherBLUE CROSS BLUE SHIELD