Provider Demographics
NPI:1326249954
Name:KAUFMANN, MARCIA MAY (LCSW LICENSED CLINIC)
Entity Type:Individual
Prefix:MRS
First Name:MARCIA
Middle Name:MAY
Last Name:KAUFMANN
Suffix:
Gender:F
Credentials:LCSW LICENSED CLINIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4990 SPEAK LANE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95118
Mailing Address - Country:US
Mailing Address - Phone:408-266-7826
Mailing Address - Fax:408-267-9649
Practice Address - Street 1:4990 SPEAK LANE
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95118
Practice Address - Country:US
Practice Address - Phone:408-266-7826
Practice Address - Fax:408-267-9649
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS54821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ91911ZMedicare ID - Type Unspecified