Healthcare Provider Details

I. General information

NPI: 1073759213
Provider Name (Legal Business Name): JULIANN EVA KAUFFMAN ED.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2008
Last Update Date: 10/01/2021
Certification Date: 10/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3484 MONROE AVE
LAFAYETTE CA
94549-4521
US

IV. Provider business mailing address

1600 S MAIN ST STE 240
WALNUT CREEK CA
94596-8811
US

V. Phone/Fax

Practice location:
  • Phone: 925-274-1477
  • Fax: 925-283-5615
Mailing address:
  • Phone: 925-274-1477
  • Fax: 925-283-5615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number17331
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number17331
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number17331
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: