Provider Demographics
NPI:1780658401
Name:KAUFMAN, NOAH K (PHD)
Entity Type:Individual
Prefix:
First Name:NOAH
Middle Name:K
Last Name:KAUFMAN
Suffix:
Gender:M
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:PO BOX 16198
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88004-6198
Mailing Address - Country:US
Mailing Address - Phone:575-526-9090
Mailing Address - Fax:575-526-8787
Practice Address - Street 1:1188 W HADLEY AVE
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-2425
Practice Address - Country:US
Practice Address - Phone:575-526-9090
Practice Address - Fax:575-526-8787
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM905103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM62350030Medicaid
NM341429506Medicare PIN