Provider Demographics
NPI:1467988436
Name:KLEIN, MARTY
Entity Type:Individual
Prefix:
First Name:MARTY
Middle Name:
Last Name:KLEIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2439 BIRCH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-1990
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2439 BIRCH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1990
Practice Address - Country:US
Practice Address - Phone:650-856-6533
Practice Address - Fax:650-858-1848
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 15392106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist