Provider Demographics
NPI:1760556963
Name:KAUFMANN, HEIDI J (MSW LCSWR)
Entity Type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:J
Last Name:KAUFMANN
Suffix:
Gender:F
Credentials:MSW LCSWR
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:K
Other - Last Name:DEKAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSWR
Mailing Address - Street 1:67 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905
Mailing Address - Country:US
Mailing Address - Phone:607-771-2172
Mailing Address - Fax:
Practice Address - Street 1:67 MAIN ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905
Practice Address - Country:US
Practice Address - Phone:607-771-2172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0206781104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01551459Medicaid
NY55415BMedicare ID - Type Unspecified