Provider Demographics
NPI:1801192877
Name:KLEIN, PATRICIA M (LMSW)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:M
Last Name:KLEIN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2841
Mailing Address - Country:US
Mailing Address - Phone:631-369-7800
Mailing Address - Fax:631-369-7898
Practice Address - Street 1:441 PENBROOKE DR STE 1
Practice Address - Street 2:
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-2046
Practice Address - Country:US
Practice Address - Phone:585-398-8835
Practice Address - Fax:585-398-7376
Is Sole Proprietor?:No
Enumeration Date:2011-02-08
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058279104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker