Provider Demographics
NPI:1972609634
Name:KAUFMAN, WENDY R (LCSW-C)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:R
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 955
Mailing Address - Street 2:
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646-0955
Mailing Address - Country:US
Mailing Address - Phone:301-753-8306
Mailing Address - Fax:301-754-4991
Practice Address - Street 1:616 CHARLES ST
Practice Address - Street 2:SUITE 106
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-5937
Practice Address - Country:US
Practice Address - Phone:301-753-8306
Practice Address - Fax:301-753-4991
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD 095641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD127510OtherAPS
MD279526OtherM.D.IPA
MD218464OtherKAISER PERMANENTE
MD322217OtherMHN
MDK103HIOtherBC/BS OF MARYLAND
MD150803OtherVALUE OPTIONS
MD2042905OtherCIGNA
MD2042905OtherCIGNA