Provider Demographics
NPI:1396311098
Name:KLETKE, PAMELA
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:KLETKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1913 ATLANTIC AVE STE 119
Mailing Address - Street 2:
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-1070
Mailing Address - Country:US
Mailing Address - Phone:908-569-1944
Mailing Address - Fax:908-332-9546
Practice Address - Street 1:1913 ATLANTIC AVE STE 119
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-1070
Practice Address - Country:US
Practice Address - Phone:908-569-1944
Practice Address - Fax:908-332-9546
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00348200101YA0400X
NJ37PC00661100101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)