Provider Demographics
NPI:1699041178
Name:KAUFOLD, MARY-ELLEN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARY-ELLEN
Middle Name:
Last Name:KAUFOLD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 OLD NORTHPORT RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2950
Mailing Address - Country:US
Mailing Address - Phone:631-525-2776
Mailing Address - Fax:
Practice Address - Street 1:49 OLD NORTHPORT RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2950
Practice Address - Country:US
Practice Address - Phone:631-525-2776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY73-078856101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health