Provider Demographics
NPI:1760598536
Name:KAUFMAN, RANDI (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RANDI
Middle Name:
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 390226
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-0022
Mailing Address - Country:US
Mailing Address - Phone:617-441-2100
Mailing Address - Fax:617-441-7705
Practice Address - Street 1:1218 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-3835
Practice Address - Country:US
Practice Address - Phone:617-441-2100
Practice Address - Fax:617-441-7705
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7815103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAKAW50968Medicare ID - Type Unspecified