Healthcare Provider Details

I. General information

NPI: 1013935287
Provider Name (Legal Business Name): JODY A KAUFMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9033 GLADES RD SUITE B
BOCA RATON FL
33434-3939
US

IV. Provider business mailing address

12581 YARDLEY DR
BOCA RATON FL
33428-4862
US

V. Phone/Fax

Practice location:
  • Phone: 561-361-0500
  • Fax: 561-479-0384
Mailing address:
  • Phone: 561-218-6226
  • Fax: 561-218-6227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW6177
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: