| Doctor Name: | LEWIS BERNARD KLEBANOFF |
| NPI Number: | 1972510295 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PHD |
| License Number: | 675 |
| Business Practice Address: | 32 Simmons Pond Rd W Dennis, MA - 026382541 |
| Business Phone Number: | 5083856813 |
| Business Fax Number: | 5083856813 |
| Mailing Address: | 32 Simmons Pond Rd W, DENNIS |
| State: | MA |
| Postal Code: | 026382541 |
| Phone Number: | 5083856813 |
| Fax Number: | 5083856813 |
| NPI Enumeration Date: | 08/01/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 675 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |