Provider Demographics
NPI:1013935287
Name:KAUFMAN, JODY A (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JODY
Middle Name:A
Last Name:KAUFMAN
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 1:12581 YARDLEY DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-4862
Mailing Address - Country:US
Mailing Address - Phone:561-218-6226
Mailing Address - Fax:561-218-6227
Practice Address - Street 1:9033 GLADES RD
Practice Address - Street 2:SUITE B
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-3939
Practice Address - Country:US
Practice Address - Phone:561-361-0500
Practice Address - Fax:561-479-0384
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW61771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE5486AMedicare ID - Type UnspecifiedMEDICARE NUMBER