Active NPI
Stan Kletkewicz Jr., MA
- Professional Counselor
- Medford, NJ
National Provider Identifier
1790143626
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 37AC00231700
- Practice address
- 66 N Main St
Medford, NJ 08055-2719 - Phone
- (856) 912-8834
- NPI assigned
- Feb 6, 2016
- Last updated
- Feb 6, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 37AC00231700 | NJ | Primary |
Addresses
Primary practice location
66 N Main St
Medford, NJ 08055-2719
Mailing address
1436 Hainesport Rd
Mount Laurel, NJ 08054-9509
Phone (856) 912-8834
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Oct 22, 2025 through Oct 22, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 37AC00231700 | NJ | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1454716800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1454716800000",
"number": "1790143626",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1436 HAINESPORT RD",
"city": "MOUNT LAUREL",
"state": "NJ",
"postal_code": "080549509",
"telephone_number": "856-912-8834"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "66 N MAIN ST",
"city": "MEDFORD",
"state": "NJ",
"postal_code": "080552719",
"telephone_number": "856-912-8834"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KLETKEWICZ",
"first_name": "STAN",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "MA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-02-06",
"last_updated": "2016-02-06",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NJ",
"license": "37AC00231700",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Medford, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.