# KENNETH M. KLEBANOW, M.D. & ASSOCIATES, P.A.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790233666
- **Authorized official:** JESSICA K. WINKLES PHD (PSYCHOLOGIST)
- **Authorized official phone:** (410) 794-4924

## Contact information

- **Practice address:** 8821 COLUMBIA 100 PKWY, COLUMBIA, MD 21045
- **Practice address phone:** (410) 997-1700
- **Practice address fax:** (410) 740-8315
- **Mailing address:** 8821 COLUMBIA 100 PKWY, COLUMBIA, MD 21045
- **Mailing address phone:** (410) 997-1700
- **Mailing address fax:** (410) 740-8315

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103TC2200X | Clinical Child & Adolescent Psychologist | 05562 | MD | Yes |

## Other

- **Enumeration date:** 09/20/2016
- **Last updated:** 07/28/2022