Provider Demographics
NPI:1871651232
Name:KLEIMAN, ADINA SUE (PH D)
Entity Type:Individual
Prefix:
First Name:ADINA
Middle Name:SUE
Last Name:KLEIMAN
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 SKOKIE BLVD.
Mailing Address - Street 2:SUITE 340
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091
Mailing Address - Country:US
Mailing Address - Phone:847-256-0055
Mailing Address - Fax:847-853-9526
Practice Address - Street 1:444 SKOKIE BLVD.
Practice Address - Street 2:SUITE 340
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091
Practice Address - Country:US
Practice Address - Phone:847-256-0055
Practice Address - Fax:847-853-9526
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071001880103T00000X, 103TC0700X
103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01673019OtherBCBS
ILR17778Medicare UPIN
ILK50503Medicare PIN