Provider Demographics
NPI:1821290594
Name:KLEINAU, DIANE LORETTA (MASTERS IN SCIENCE)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:LORETTA
Last Name:KLEINAU
Suffix:
Gender:F
Credentials:MASTERS IN SCIENCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 SERRELL AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-3416
Mailing Address - Country:US
Mailing Address - Phone:718-605-0440
Mailing Address - Fax:
Practice Address - Street 1:178 MORRISON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310-2835
Practice Address - Country:US
Practice Address - Phone:718-442-3646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool