Provider Demographics
NPI:1396968020
Name:KLEIN, BETH (PHD)
Entity type:Individual
Prefix:DR
First Name:BETH
Middle Name:
Last Name:KLEIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20421 SW 51ST ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33332-1565
Mailing Address - Country:US
Mailing Address - Phone:954-423-4231
Mailing Address - Fax:954-423-4231
Practice Address - Street 1:1625 N COMMERCE PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3216
Practice Address - Country:US
Practice Address - Phone:954-423-4231
Practice Address - Fax:954-423-4231
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0005943103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL320179549OtherTRICARE
FLBK 54459OtherBCBS
FLPTAN077ZMedicare PIN