Provider Demographics
NPI:1316452014
Name:KLEIN, THEODORE WINSTON (LCSW)
Entity type:Individual
Prefix:
First Name:THEODORE
Middle Name:WINSTON
Last Name:KLEIN
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6060 PIEDMONT ROW DR S STE 500
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28287-3803
Mailing Address - Country:US
Mailing Address - Phone:855-501-1004
Mailing Address - Fax:855-916-1801
Practice Address - Street 1:2510 WESTCHESTER AVE STE 202
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-3585
Practice Address - Country:US
Practice Address - Phone:855-681-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-05
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC01711301041C0700X
NY0963411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical