Provider Demographics
NPI:1124320049
Name:KLEIN, VICKI (PSYD)
Entity type:Individual
Prefix:DR
First Name:VICKI
Middle Name:
Last Name:KLEIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 WOOLEYS LN
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-2325
Mailing Address - Country:US
Mailing Address - Phone:516-482-1104
Mailing Address - Fax:
Practice Address - Street 1:220 S SERVICE RD
Practice Address - Street 2:SUITE 14
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-2129
Practice Address - Country:US
Practice Address - Phone:516-621-8421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-29
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4255BKMedicaid