Provider Demographics
NPI:1376758870
Name:KLEINER, FREDRIC BARRY (PHD)
Entity Type:Individual
Prefix:
First Name:FREDRIC
Middle Name:BARRY
Last Name:KLEINER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 E WEST HWY
Mailing Address - Street 2:SUITE 307
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-4523
Mailing Address - Country:US
Mailing Address - Phone:301-652-2120
Mailing Address - Fax:301-657-9224
Practice Address - Street 1:4401 EAST WEST HIGHWAY
Practice Address - Street 2:SUITE 307
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-4526
Practice Address - Country:US
Practice Address - Phone:301-652-2120
Practice Address - Fax:301-657-9224
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00640103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD9496009Medicaid
MD9496009Medicaid