Provider Demographics
NPI:1427482561
Name:KLEINSMITH, AMY S (MT-BC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:S
Last Name:KLEINSMITH
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 VERNON AVE
Mailing Address - Street 2:#24
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-4329
Mailing Address - Country:US
Mailing Address - Phone:484-336-7363
Mailing Address - Fax:
Practice Address - Street 1:122 WINDSOR AVE
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06451-2900
Practice Address - Country:US
Practice Address - Phone:860-518-5557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10811225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist