Provider Demographics
NPI:1952421505
Name:KLEIN, KAREN SUE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:SUE
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 1:263 SIDELINGER RD
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:ME
Mailing Address - Zip Code:04862-5647
Mailing Address - Country:US
Mailing Address - Phone:207-785-6229
Mailing Address - Fax:
Practice Address - Street 1:328 MAIN ST
Practice Address - Street 2:#202
Practice Address - City:ROCKLAND
Practice Address - State:ME
Practice Address - Zip Code:04841-3365
Practice Address - Country:US
Practice Address - Phone:207-594-5102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS618103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME003345OtherANTHEM BC BS
MEKLMM 2883Medicare ID - Type UnspecifiedMEDICARE