Provider Demographics
NPI:1740963800
Name:KAUFFMAN, TRACY L (LCSW)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:L
Last Name:KAUFFMAN
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 1:920 W EXECUTIVE CT
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:IN
Mailing Address - Zip Code:47960-1961
Mailing Address - Country:US
Mailing Address - Phone:574-583-9350
Mailing Address - Fax:
Practice Address - Street 1:920 W EXECUTIVE CT
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:IN
Practice Address - Zip Code:47960-1961
Practice Address - Country:US
Practice Address - Phone:574-583-9350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34010541A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical