Provider Demographics
NPI:1629160304
Name:KLOT, GREGG (LCSW, PHD)
Entity Type:Individual
Prefix:DR
First Name:GREGG
Middle Name:
Last Name:KLOT
Suffix:
Gender:M
Credentials:LCSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 PROSPECT PARK SW APT F1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-1266
Mailing Address - Country:US
Mailing Address - Phone:917-653-7260
Mailing Address - Fax:917-653-7260
Practice Address - Street 1:135 PROSPECT PARK SW APT F1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-1266
Practice Address - Country:US
Practice Address - Phone:917-653-7260
Practice Address - Fax:917-653-7260
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1052141041C0700X
DEQL-00119161041C0700X
CT114641041C0700X
NJ44SC060129001041C0700X
NYR037061-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN79751Medicare UPIN