Provider Demographics
NPI:1760664601
Name:KAUFMAN, RAOUL L (MARRIAGE FAMILY THER)
Entity Type:Individual
Prefix:DR
First Name:RAOUL
Middle Name:L
Last Name:KAUFMAN
Suffix:
Gender:M
Credentials:MARRIAGE FAMILY THER
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 17941
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96151-7941
Mailing Address - Country:US
Mailing Address - Phone:530-544-1668
Mailing Address - Fax:530-542-3803
Practice Address - Street 1:2311 LAKE TAHOE BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150
Practice Address - Country:US
Practice Address - Phone:530-544-1668
Practice Address - Fax:530-544-1668
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC15382106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist