Provider Demographics
NPI:1851727606
Name:KLEIN, BENJAMIN SAMUEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:SAMUEL
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 1:281 WINDSOR PL
Mailing Address - Street 2:APT. 8
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-1227
Mailing Address - Country:US
Mailing Address - Phone:917-232-8860
Mailing Address - Fax:
Practice Address - Street 1:410 E 92ND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-6881
Practice Address - Country:US
Practice Address - Phone:212-831-3667
Practice Address - Fax:212-831-5254
Is Sole Proprietor?:No
Enumeration Date:2013-09-24
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1284837103TS0200X
NY020863103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1284837OtherSCHOOL PSYCHOLOGIST CERTIFICATION
NY020863OtherLICENSED CLINICAL PSYCHOLOGIST