Provider Demographics
NPI:1831250257
Name:KAUFMAN, NAN ELLIN (MSW)
Entity type:Individual
Prefix:
First Name:NAN
Middle Name:ELLIN
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3203 TURNER LN
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-3219
Mailing Address - Country:US
Mailing Address - Phone:301-986-9020
Mailing Address - Fax:
Practice Address - Street 1:4400 E WEST HWY
Practice Address - Street 2:SUITE 720
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-4524
Practice Address - Country:US
Practice Address - Phone:301-986-9020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05834101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD646725Medicare ID - Type UnspecifiedMSW