Provider Demographics
NPI:1558372136
Name:KAUFMAN, RONALD LOUIS (PSYD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:LOUIS
Last Name:KAUFMAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12501 CHANDLER BLVD
Mailing Address - Street 2:102
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CALIFORNIA
Mailing Address - Zip Code:91607
Mailing Address - Country:UM
Mailing Address - Phone:310-850-9813
Mailing Address - Fax:818-821-6014
Practice Address - Street 1:12501 CHANDLER BLVD
Practice Address - Street 2:102
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-1941
Practice Address - Country:US
Practice Address - Phone:818-821-6012
Practice Address - Fax:818-821-6014
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 17178103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY 171780Medicaid
CAPSY 171780Medicaid