Provider Demographics
NPI:1295291078
Name:KLEIN, SIRIPORN JENNY (PSYD)
Entity type:Individual
Prefix:DR
First Name:SIRIPORN
Middle Name:JENNY
Last Name:KLEIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1124 31ST AVE
Mailing Address - Street 2:APT 6E
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-4878
Mailing Address - Country:US
Mailing Address - Phone:917-601-7486
Mailing Address - Fax:
Practice Address - Street 1:353 LEXINGTON AVE
Practice Address - Street 2:# 308
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-0941
Practice Address - Country:US
Practice Address - Phone:917-601-7486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-16
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022968-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical