Provider Demographics
NPI:1477787802
Name:KLIGER, JARED (PSYD)
Entity type:Individual
Prefix:MR
First Name:JARED
Middle Name:
Last Name:KLIGER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4616 WILLIS AVE
Mailing Address - Street 2:APT 204
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-6016
Mailing Address - Country:US
Mailing Address - Phone:310-906-0129
Mailing Address - Fax:818-584-8844
Practice Address - Street 1:547 S MARENGO AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-3114
Practice Address - Country:US
Practice Address - Phone:310-906-0129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22666103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY22666OtherMEDICAL LICENSE