Provider Demographics
NPI:1689615833
Name:KAUFMAN, RICHARD ROBERT (LICSW)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ROBERT
Last Name:KAUFMAN
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:286 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:FISKDALE
Mailing Address - State:MA
Mailing Address - Zip Code:01518-1014
Mailing Address - Country:US
Mailing Address - Phone:508-347-0033
Mailing Address - Fax:508-885-1118
Practice Address - Street 1:185 MAIN ST
Practice Address - Street 2:SUITE 11
Practice Address - City:SPENCER
Practice Address - State:MA
Practice Address - Zip Code:01562-1755
Practice Address - Country:US
Practice Address - Phone:508-885-5238
Practice Address - Fax:508-885-1118
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1047211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP02929Medicare ID - Type Unspecified