Provider Demographics
NPI:1154629517
Name:KLASS, ELLEN TOBEY (PHD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:TOBEY
Last Name:KLASS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 W 17TH ST
Mailing Address - Street 2:3A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-5715
Mailing Address - Country:US
Mailing Address - Phone:212-242-0132
Mailing Address - Fax:
Practice Address - Street 1:40 W 17TH ST
Practice Address - Street 2:3A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-5715
Practice Address - Country:US
Practice Address - Phone:212-242-0132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPSY 5042103TB0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral