Provider Demographics
NPI:1942403563
Name:KAFFKA, BETH LOUISE (LCSW)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:LOUISE
Last Name:KAFFKA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1747 OAK AVE
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-1004
Mailing Address - Country:US
Mailing Address - Phone:530-753-7272
Mailing Address - Fax:530-758-7099
Practice Address - Street 1:1747 OAK AVE
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-1004
Practice Address - Country:US
Practice Address - Phone:530-753-7272
Practice Address - Fax:530-758-7099
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA178941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical