MEDICARE: STACEY KAUFFMAN LMSW

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
1	101YM0800X	Mental Health Counselor	25664	MD

General Provider Information

NPI Number	:	1629760517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEY KAUFFMAN LMSW

Provider Business Mailing Address
First Line	:	8101 SANDY SPRING RD STE 250N
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20707-3527
Country	:	US
Telephone Number	:	800-994-5403
Fax Number	:

Provider Business Practice Location Address
First Line	:	274 BOBWHITE WAY
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78253-6977
Country	:	US
Telephone Number	:	210-793-2284
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2023
Last Update Date	:	05/24/2023

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