Provider Demographics
NPI:1194191098
Name:KAUFMAN, MARCI
Entity Type:Individual
Prefix:
First Name:MARCI
Middle Name:
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 PARK BLVD
Mailing Address - Street 2:SUITE #B102
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-1931
Mailing Address - Country:US
Mailing Address - Phone:516-996-6693
Mailing Address - Fax:
Practice Address - Street 1:2425 PARK BLVD
Practice Address - Street 2:SUITE #B102
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1931
Practice Address - Country:US
Practice Address - Phone:516-996-6693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-13
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA296461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical