Provider Demographics
NPI:1306817994
Name:KAUFMAN, MARCIA BONNIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:BONNIE
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 1:115 PARK ST SE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-4653
Mailing Address - Country:US
Mailing Address - Phone:703-938-9090
Mailing Address - Fax:703-938-9091
Practice Address - Street 1:115 PARK ST SE
Practice Address - Street 2:SUITE 207
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4653
Practice Address - Country:US
Practice Address - Phone:703-938-9090
Practice Address - Fax:703-938-9091
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006137L103T00000X
VAVA0810004426103T00000X
DCPSY1000608103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist