Provider Demographics
NPI:1144405010
Name:KLAVENS, GEORGE S (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:S
Last Name:KLAVENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 BEACON ST
Mailing Address - Street 2:SUITE 7 WEST
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-4626
Mailing Address - Country:US
Mailing Address - Phone:617-731-4884
Mailing Address - Fax:
Practice Address - Street 1:1501 BEACON ST
Practice Address - Street 2:SUITE 7 WEST
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-4626
Practice Address - Country:US
Practice Address - Phone:617-731-4884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA79467102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY02671Medicare PIN