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NPI Code Detail

MEDICARE: BROOKE KAUFMAN PSYD

MEDICARE: BROOKE KAUFMAN PSYD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologistPSB94027511CA

General Provider Information

NPI Number : 1508642224
Entity Type Code : Individual
Provider Name (Legal Business Name) : BROOKE KAUFMAN PSYD
Provider Business Mailing Address
First Line : 555 GRAND BLVD
Second Line :
City : VENICE
State : CA
Zip : 90291-4224
Country : US
Telephone Number : 818-404-1204
Fax Number :
Provider Business Practice Location Address
First Line : 3306 GLENDALE BLVD STE 7
Second Line :
City : LOS ANGELES
State : CA
Zip : 90039-1838
Country : US
Telephone Number : 323-206-6307
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/07/2023
Last Update Date : 09/07/2023

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