Provider Demographics
NPI:1689865735
Name:KLEIN, RICHARD S (PHD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:S
Last Name:KLEIN
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 1:150 N SANTA ANITA AVE STE 735
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-3145
Mailing Address - Country:US
Mailing Address - Phone:626-462-5810
Mailing Address - Fax:626-446-9686
Practice Address - Street 1:150 N SANTA ANITA AVE STE 735
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3145
Practice Address - Country:US
Practice Address - Phone:626-462-5810
Practice Address - Fax:626-446-9686
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY004152103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR14326Medicare UPIN