Provider Demographics
NPI:1295295616
Name:KLEBANOFF, SAMI MEG
Entity type:Individual
Prefix:DR
First Name:SAMI
Middle Name:MEG
Last Name:KLEBANOFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1766 WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-2246
Mailing Address - Country:US
Mailing Address - Phone:323-449-3300
Mailing Address - Fax:
Practice Address - Street 1:12522 MOORPARK ST
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-1355
Practice Address - Country:US
Practice Address - Phone:818-661-6306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-21
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician