Provider Demographics
NPI:1881729499
Name:KAUFMAN, MANDY LEA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MANDY
Middle Name:LEA
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MANDY
Other - Middle Name:LEA
Other - Last Name:TOBIAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:105 ARBOR FOREST CT
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-4517
Mailing Address - Country:US
Mailing Address - Phone:770-843-8662
Mailing Address - Fax:
Practice Address - Street 1:4549 CHAMBLEE DUNWOODY RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-6210
Practice Address - Country:US
Practice Address - Phone:770-677-9392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0033091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA80BBFVMMedicare ID - Type Unspecified