Provider Demographics
NPI:1467413401
Name:KAUFMAN, JACQUELINE MARIE (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:MARIE
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:MS
Other - First Name:JACQUELINE
Other - Middle Name:MARIE
Other - Last Name:THOEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-R
Mailing Address - Street 1:45 KNOLLWOOD ROAD
Mailing Address - Street 2:SUITE 502
Mailing Address - City:ELMSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:10532
Mailing Address - Country:US
Mailing Address - Phone:914-512-0507
Mailing Address - Fax:
Practice Address - Street 1:45 KNOLLWOOD ROAD
Practice Address - Street 2:SUITE 502
Practice Address - City:ELMSFORD
Practice Address - State:NY
Practice Address - Zip Code:10532
Practice Address - Country:US
Practice Address - Phone:845-534-2926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-0712801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN2Y371Medicare ID - Type Unspecified