Provider Demographics
NPI:1982687315
Name:KLINE, KENNETH S (PHD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:S
Last Name:KLINE
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 1:392 CENTRAL PARK W
Mailing Address - Street 2:STE 8M
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-5860
Mailing Address - Country:US
Mailing Address - Phone:212-222-2126
Mailing Address - Fax:212-222-2126
Practice Address - Street 1:392 CENTRAL PARK W
Practice Address - Street 2:STE 8M
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-5860
Practice Address - Country:US
Practice Address - Phone:212-222-2126
Practice Address - Fax:212-222-2126
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0066630103T00000X
NJ35SI00320100103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
V62801OtherEMPIRE BCBS NY
NY151129OtherMANAGED HEALTH MUTUAL
NYY041125OtherTRICARE/CHAMPUS
NY060006663NY01OtherANTHEM HEALTH
NJ151129OtherMANAGED HEALTH MUTUAL
NY121835000OtherMAGELLAN BEH HEALTH
NJJ022890OtherTRICARE/CHAMPUS
NJ060006663NY01OtherANTHEM HEALTH
NYI5408OtherOXFORD
NY0068815OtherGHI GHI BMP
NJ0068815OtherGHI GHI BMP
NJI5408OtherOXFORD
NY00916481Medicaid
NJ610010YMedicaid
NJI5408OtherOXFORD
NYI5408OtherOXFORD