Provider Demographics
NPI:1609932995
Name:KAUFMAN, EDWARD PHILLIP (LCSW)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:PHILLIP
Last Name:KAUFMAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 CENTRAL AVE STE 212
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-3271
Mailing Address - Country:US
Mailing Address - Phone:847-432-7440
Mailing Address - Fax:847-432-7340
Practice Address - Street 1:508 CENTRAL AVE STE 212
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-3271
Practice Address - Country:US
Practice Address - Phone:847-432-7440
Practice Address - Fax:847-432-7340
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical