Provider Demographics
NPI:1336426808
Name:KLEIN, ELIZABETH A (MSW)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:A
Last Name:KLEIN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:LIBBY
Other - Middle Name:A
Other - Last Name:KLEIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:1178 W LAURELTON PKWY
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-2749
Mailing Address - Country:US
Mailing Address - Phone:201-937-2974
Mailing Address - Fax:
Practice Address - Street 1:71 FRANKLIN TPKE
Practice Address - Street 2:SUITE 2-6
Practice Address - City:WALDWICK
Practice Address - State:NJ
Practice Address - Zip Code:07463-1851
Practice Address - Country:US
Practice Address - Phone:201-937-2974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC007575001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical