Provider Demographics
NPI:1922213990
Name:KAUFMAN, AMY (DMH)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:DMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 ETHEL AVE
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-2764
Mailing Address - Country:US
Mailing Address - Phone:415-460-9027
Mailing Address - Fax:
Practice Address - Street 1:179 ETHEL AVE
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-2764
Practice Address - Country:US
Practice Address - Phone:415-460-9027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 10930101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health