Provider Demographics
NPI:1922263276
Name:KLEIN, LUCAS ADAM (PHD)
Entity Type:Individual
Prefix:DR
First Name:LUCAS
Middle Name:ADAM
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 1:731 S HIGHWAY 101
Mailing Address - Street 2:SUITE 1-E
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-2629
Mailing Address - Country:US
Mailing Address - Phone:619-244-0336
Mailing Address - Fax:
Practice Address - Street 1:731 S HIGHWAY 101
Practice Address - Street 2:SUITE 1-E
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-2629
Practice Address - Country:US
Practice Address - Phone:619-244-0336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-25
Last Update Date:2013-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103G00000X, 103TC2200X, 103T00000X
CT003257103TC0700X
NY019804103T00000X
CAPSY 25861103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1154767515OtherGROUP NPI NUMBER