Provider Demographics
NPI:1770572026
Name:KLEIN, JANE L (LCSW)
Entity type:Individual
Prefix:MS
First Name:JANE
Middle Name:L
Last Name:KLEIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 HARRIS AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-4305
Mailing Address - Country:US
Mailing Address - Phone:718-982-9122
Mailing Address - Fax:781-982-9122
Practice Address - Street 1:711 HARRIS AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-4305
Practice Address - Country:US
Practice Address - Phone:718-982-9122
Practice Address - Fax:781-982-9122
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRP048198-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11461335OtherUBH
NM706065000OtherMHN
NYN497Y1OtherEMPIRE MEDICARE
NY7338219OtherGROUP HEALTH INSURANCE
NYP-12001072OtherMULTIPLAN
NY373234OtherVALUE OPTIONS
NYP2878510OtherOXFORD BEHAVIORAL HEALTH
NM100691POtherHIP
NY373234OtherVALUE OPTIONS