Provider Demographics
NPI:1891995734
Name:KAUFMAN, ROBERT PAGE (LCSW/MA)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:PAGE
Last Name:KAUFMAN
Suffix:
Gender:M
Credentials:LCSW/MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 CAMINO PINON
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-1903
Mailing Address - Country:US
Mailing Address - Phone:505-930-1477
Mailing Address - Fax:
Practice Address - Street 1:17 CAMINO PINON
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87508-1903
Practice Address - Country:US
Practice Address - Phone:505-930-1477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-067131041C0700X
NM060201041C0700X
NMC-067131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM71957332Medicaid