Healthcare Provider Details

I. General information

NPI: 1144336629
Provider Name (Legal Business Name): IRA S KAUFMAN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
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

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

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW6213
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR018148
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: