Provider Demographics
NPI:1144622200
Name:KAUFFROTH, ANNETTE (LCSW)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:KAUFFROTH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12904 PEGASUS ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78727-3036
Mailing Address - Country:US
Mailing Address - Phone:512-657-3896
Mailing Address - Fax:
Practice Address - Street 1:7703 N LAMAR BLVD STE 230
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-1069
Practice Address - Country:US
Practice Address - Phone:512-657-3896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-20
Last Update Date:2014-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX541961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical