Provider Demographics
NPI:1760525844
Name:KAUFMAN, GREGORY C
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:C
Last Name:KAUFMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 OAKBROOK DR
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-4806
Mailing Address - Country:US
Mailing Address - Phone:727-254-3528
Mailing Address - Fax:
Practice Address - Street 1:3050 1ST AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33712-1010
Practice Address - Country:US
Practice Address - Phone:727-328-3285
Practice Address - Fax:727-328-5509
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 697101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL764638100Medicaid