Provider Demographics
NPI:1518095165
Name:KLEIN, MADELINE J (LICSW)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:J
Last Name:KLEIN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 GOVERNOR ST
Mailing Address - Street 2:UNIT 2
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-3239
Mailing Address - Country:US
Mailing Address - Phone:401-273-5533
Mailing Address - Fax:
Practice Address - Street 1:208 GOVERNOR ST
Practice Address - Street 2:UNIT 2
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906
Practice Address - Country:US
Practice Address - Phone:401-273-5533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW003961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI809007488Medicare ID - Type UnspecifiedMEDICARE
RI62-74936Medicare UPIN
RI406503Medicare UPIN
RI7488-7Medicare UPIN