Provider Demographics
NPI:1417033358
Name:KAUFMAN, MICHELE S (PSYD)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:S
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 E 64TH ST
Mailing Address - Street 2:APT. 5F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-7572
Mailing Address - Country:US
Mailing Address - Phone:718-696-4122
Mailing Address - Fax:718-231-0833
Practice Address - Street 1:CHILD ADVOCACY CENTER
Practice Address - Street 2:3380 RESERVOIR OVAL
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467
Practice Address - Country:US
Practice Address - Phone:718-696-4122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013645103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist