Provider Demographics
NPI:1891908307
Name:KAUFMAN, CAROL WALTER (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:WALTER
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 1:311 NE 8TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-4738
Mailing Address - Country:US
Mailing Address - Phone:305-968-6683
Mailing Address - Fax:
Practice Address - Street 1:311 NE 8TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4738
Practice Address - Country:US
Practice Address - Phone:305-968-6683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6737103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical