Provider Demographics
NPI:1558304089
Name:KLEIN, PAUL YEHUDA (PSYD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:YEHUDA
Last Name:KLEIN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 CAMBRIDGE AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-1608
Mailing Address - Country:US
Mailing Address - Phone:650-921-1188
Mailing Address - Fax:831-338-4440
Practice Address - Street 1:415 CAMBRIDGE AVENUE SUITE 4
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1600
Practice Address - Country:US
Practice Address - Phone:650-921-1188
Practice Address - Fax:831-338-4440
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19125103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY 19125OtherCLINICAL PSYCHOLOGIST #