Provider Demographics
NPI:1740358654
Name:KLEIN, ELIZABETH FAYNE (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:FAYNE
Last Name:KLEIN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MS
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:KLEIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:2410 SE 121ST AVE
Mailing Address - Street 2:SUITE #216
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-4066
Mailing Address - Country:US
Mailing Address - Phone:503-335-5975
Mailing Address - Fax:503-335-5974
Practice Address - Street 1:2410 SE 121ST AVE
Practice Address - Street 2:SUITE #216
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-4066
Practice Address - Country:US
Practice Address - Phone:503-335-5975
Practice Address - Fax:503-335-5974
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL37101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical