Provider Demographics
NPI:1881195923
Name:KLEIN, TAYLOR MARIE
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:MARIE
Last Name:KLEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:JOHNSON
Mailing Address - State:NY
Mailing Address - Zip Code:10933-0010
Mailing Address - Country:US
Mailing Address - Phone:845-239-6783
Mailing Address - Fax:
Practice Address - Street 1:842 ROUTE 284
Practice Address - Street 2:
Practice Address - City:WESTTOWN
Practice Address - State:NY
Practice Address - Zip Code:10998-3449
Practice Address - Country:US
Practice Address - Phone:845-239-6783
Practice Address - Fax:845-239-6783
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJN10087024OtherAETNA