Provider Demographics
NPI:1942674957
Name:KAUFMAN, MARTHA BURKE (LICSW)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:BURKE
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:B
Other - Last Name:KAUFMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:L,I,C,S,W,
Mailing Address - Street 1:6 COLLEEN MARY WAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02375-1281
Mailing Address - Country:US
Mailing Address - Phone:508-238-7694
Mailing Address - Fax:
Practice Address - Street 1:6 COLLEEN MARY WAY
Practice Address - Street 2:
Practice Address - City:SOUTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02375-1281
Practice Address - Country:US
Practice Address - Phone:508-238-7694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-16
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1025961104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker