Provider Demographics
NPI:1801881263
Name:KLEIN, CAROL L (ED D)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:L
Last Name:KLEIN
Suffix:
Gender:F
Credentials:ED D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 HOLLYHOCK DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19444-2105
Mailing Address - Country:US
Mailing Address - Phone:610-825-4122
Mailing Address - Fax:610-825-9056
Practice Address - Street 1:105 HOLLYHOCK DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE HILL
Practice Address - State:PA
Practice Address - Zip Code:19444-2105
Practice Address - Country:US
Practice Address - Phone:610-825-4122
Practice Address - Fax:610-825-9056
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool