Provider Demographics
NPI:1023332681
Name:KLEIN, SHARON LYNN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:LYNN
Last Name:KLEIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:LYNN
Other - Last Name:BULLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2158 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-4223
Mailing Address - Country:US
Mailing Address - Phone:631-835-4869
Mailing Address - Fax:
Practice Address - Street 1:3209 MILBURN AVE
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-4932
Practice Address - Country:US
Practice Address - Phone:516-826-1837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-24
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY78517381041C0700X
NY11180611041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool