Provider Demographics
NPI:1902820871
Name:KLEIN, MARTIN HAROLD (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:HAROLD
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 1:123 SAXONWOOD RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-2362
Mailing Address - Country:US
Mailing Address - Phone:203-915-0601
Mailing Address - Fax:
Practice Address - Street 1:64 POST RD W
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-4208
Practice Address - Country:US
Practice Address - Phone:203-915-0601
Practice Address - Fax:203-292-9845
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001909103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT680001594Medicare ID - Type Unspecified