Provider Demographics
NPI:1780845396
Name:KAUFFMAN, CASSANDRA MARY (PSYD)
Entity type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:MARY
Last Name:KAUFFMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 ALPINE BLVD
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:CA
Mailing Address - Zip Code:91901-2113
Mailing Address - Country:US
Mailing Address - Phone:619-659-3122
Mailing Address - Fax:
Practice Address - Street 1:2120 ALPINE BLVD
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:CA
Practice Address - Zip Code:91901-2113
Practice Address - Country:US
Practice Address - Phone:619-659-3122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 25899103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical