Provider Demographics
NPI:1568513109
Name:KAUFMAN, JOHN G (MSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:G
Last Name:KAUFMAN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 KILBOURN ST
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-1920
Mailing Address - Country:US
Mailing Address - Phone:574-294-6853
Mailing Address - Fax:574-266-8066
Practice Address - Street 1:1750 KILBOURN ST
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-1920
Practice Address - Country:US
Practice Address - Phone:574-294-6853
Practice Address - Fax:574-266-8066
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34002356A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical