Provider Demographics
NPI:1689035347
Name:KLINGE, ALICE DENISE (MED,CAGS)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:DENISE
Last Name:KLINGE
Suffix:
Gender:F
Credentials:MED,CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:SHELBURNE FALLS
Mailing Address - State:MA
Mailing Address - Zip Code:01370-1038
Mailing Address - Country:US
Mailing Address - Phone:413-219-2884
Mailing Address - Fax:
Practice Address - Street 1:123 NORTH ST
Practice Address - Street 2:
Practice Address - City:BUCKLAND
Practice Address - State:MA
Practice Address - Zip Code:01388
Practice Address - Country:US
Practice Address - Phone:413-219-2884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-09
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health