Provider Demographics
NPI:1992766281
Name:KLEIN, ELLEN P (MSW)
Entity type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:P
Last Name:KLEIN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 SOUTHVIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-1546
Mailing Address - Country:US
Mailing Address - Phone:706-369-0697
Mailing Address - Fax:706-369-0852
Practice Address - Street 1:390 SOUTHVIEW DRIVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-1546
Practice Address - Country:US
Practice Address - Phone:706-369-0697
Practice Address - Fax:706-369-0852
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0007911041C0700X
GA000578106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA80BBBCGMedicare ID - Type Unspecified