Healthcare Provider Details

I. General information

NPI: 1174857585
Provider Name (Legal Business Name): JESSICA JANE KAUFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2009
Last Update Date: 10/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 MASON CIR SUITE A
CONCORD CA
94520-1203
US

IV. Provider business mailing address

205 MASON CIR SUITE A
CONCORD CA
94520-1203
US

V. Phone/Fax

Practice location:
  • Phone: 925-521-1270
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: