Provider Demographics
NPI:1316255342
Name:KLEINBAUM, ALFRED WILLIAM (PHD)
Entity type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:WILLIAM
Last Name:KLEINBAUM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:653 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-2865
Mailing Address - Country:US
Mailing Address - Phone:917-734-7143
Mailing Address - Fax:
Practice Address - Street 1:11 RIVERSIDE DR
Practice Address - Street 2:SUITE W4
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-2504
Practice Address - Country:US
Practice Address - Phone:917-734-7143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY11541103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical