Provider Demographics
NPI:1780141838
Name:KAUFMAN, JENNIFER ELIZABETH
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ELIZABETH
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:KAUFMAN
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LPC, NCC, QMHP
Mailing Address - Street 1:34380 BLOOMFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BLUEMONT
Mailing Address - State:VA
Mailing Address - Zip Code:20135-2103
Mailing Address - Country:US
Mailing Address - Phone:703-226-9815
Mailing Address - Fax:
Practice Address - Street 1:3704 MACOMB ST NW STE 3
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-3829
Practice Address - Country:US
Practice Address - Phone:703-226-9815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC15037101YP2500X
VA0701008154101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional