Provider Demographics
NPI:1740220722
Name:KAUFMAN, JANICE MERYL (PHD)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:MERYL
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-1900
Mailing Address - Country:US
Mailing Address - Phone:781-721-7311
Mailing Address - Fax:781-756-1919
Practice Address - Street 1:611 MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-1900
Practice Address - Country:US
Practice Address - Phone:781-721-7311
Practice Address - Fax:781-756-1919
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3990103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW03921Medicare ID - Type Unspecified