Basic Information
| Provider Information | |||||||||
| NPI: | 1851325492 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KLEINKLAUS | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | A | ||||||||
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| Mailing Information | |||||||||
| Address1: | CEDAR HOUSE 201 CEDAR ST. | ||||||||
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| City: | ONEIDA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 13421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3153618413 | ||||||||
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| Practice Location | |||||||||
| Address1: | 201 CEDAR ST | ||||||||
| Address2: | |||||||||
| City: | ONEIDA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 134212111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3153618413 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 0319351 | NY | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.