Provider Demographics
NPI:1366751869
Name:KLEINBERG, JEFFRY ALAN (PHD)
Entity type:Individual
Prefix:DR
First Name:JEFFRY
Middle Name:ALAN
Last Name:KLEINBERG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 LINDA VISTA DR SPC 288
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-6342
Mailing Address - Country:US
Mailing Address - Phone:858-722-6705
Mailing Address - Fax:833-933-0631
Practice Address - Street 1:3535 LINDA VISTA DR SPC 288
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-6342
Practice Address - Country:US
Practice Address - Phone:858-722-6705
Practice Address - Fax:833-933-0631
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-30
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFTI 61866106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist