Provider Demographics
NPI:1225589823
Name:KAUFMAN, MARK BRIAN
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:BRIAN
Last Name:KAUFMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3938 T ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-4730
Mailing Address - Country:US
Mailing Address - Phone:916-823-5523
Mailing Address - Fax:916-382-9583
Practice Address - Street 1:3938 T ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-4730
Practice Address - Country:US
Practice Address - Phone:916-823-5523
Practice Address - Fax:916-382-9583
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAK0703071101101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)