Provider Demographics
NPI:1073648572
Name:KAUFMAN, LAURIE B (PHD)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:B
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-2459
Mailing Address - Country:US
Mailing Address - Phone:401-213-5188
Mailing Address - Fax:
Practice Address - Street 1:44 SPRING ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-2459
Practice Address - Country:US
Practice Address - Phone:401-213-5188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
RIPS01148103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1312677Medicaid
MAM18708OtherBLUE CROSS
MA685661OtherTUFTS
MA1312677Medicaid