Provider Demographics
NPI:1962421032
Name:KLEIN, DOROTHY R (LCSW)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:R
Last Name:KLEIN
Suffix:
Gender:F
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:PO BOX 220627
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33422-0627
Mailing Address - Country:US
Mailing Address - Phone:561-684-1991
Mailing Address - Fax:561-828-9272
Practice Address - Street 1:5841 CORPORATE WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2039
Practice Address - Country:US
Practice Address - Phone:561-684-1991
Practice Address - Fax:561-828-9272
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW63501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ009POtherBCBS
FLE7953ZMedicare PIN