Provider Demographics
NPI:1881076057
Name:KAUFMAN, AMY (PHD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 COVINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-5375
Mailing Address - Country:US
Mailing Address - Phone:760-481-9780
Mailing Address - Fax:
Practice Address - Street 1:830 E VISTA WAY
Practice Address - Street 2:SUITE 108
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-5215
Practice Address - Country:US
Practice Address - Phone:760-230-5251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-24
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA13557321OtherCAQH