Provider Demographics
NPI:1417965567
Name:KLEIN, MARY CAROL (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:CAROL
Last Name:KLEIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:HIGGINS
Other - Last Name:KLEIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:3151 AIRWAY AVE
Mailing Address - Street 2:SUITE K-240
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4607
Mailing Address - Country:US
Mailing Address - Phone:714-957-1234
Mailing Address - Fax:714-957-1234
Practice Address - Street 1:3151 AIRWAY AVE
Practice Address - Street 2:SUITE K-240
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4607
Practice Address - Country:US
Practice Address - Phone:714-957-1234
Practice Address - Fax:714-957-1234
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS104471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical