Provider Demographics
NPI:1730490061
Name:KLEIN, CHRISTIAN EDWARD
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:EDWARD
Last Name:KLEIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 WRIGHTS MILL RD
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:CT
Mailing Address - Zip Code:06238-1534
Mailing Address - Country:US
Mailing Address - Phone:860-742-4232
Mailing Address - Fax:
Practice Address - Street 1:119 WRIGHTS MILL RD
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:CT
Practice Address - Zip Code:06238-1534
Practice Address - Country:US
Practice Address - Phone:860-742-4232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-01
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0070131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical