Provider Demographics
NPI:1306103098
Name:KLEIN, ANGELA SUE (PHD)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:SUE
Last Name:KLEIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:ANGELA
Other - Middle Name:SUE
Other - Last Name:CAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:2683 STATE ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-1627
Mailing Address - Country:US
Mailing Address - Phone:573-289-4651
Mailing Address - Fax:
Practice Address - Street 1:2683 STATE ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1627
Practice Address - Country:US
Practice Address - Phone:573-289-4651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-18
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25219103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical