Provider Demographics
NPI:1497779235
Name:KLINE, JEFFREY SCHREIBER (PHD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:SCHREIBER
Last Name:KLINE
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 1:560 KENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-5113
Mailing Address - Country:US
Mailing Address - Phone:650-329-8904
Mailing Address - Fax:650-329-8914
Practice Address - Street 1:1187 UNIVERSITY DR STE 3
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4423
Practice Address - Country:US
Practice Address - Phone:650-329-8904
Practice Address - Fax:650-329-8914
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10811103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL108110Medicare ID - Type UnspecifiedMEDICARE