Healthcare Provider Details

I. General information

NPI: 1982845780
Provider Name (Legal Business Name): SANDRA PAULA KAUFMAN LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SANDRA PAULA TZODIKOV LCSW-C

II. Dates (important events)

Enumeration Date: 03/09/2009
Last Update Date: 03/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 W MONTGOMERY AVE SUITE 110
ROCKVILLE MD
20850-4216
US

IV. Provider business mailing address

50 W MONTGOMERY AVE SUITE 110
ROCKVILLE MD
20850-4216
US

V. Phone/Fax

Practice location:
  • Phone: 301-251-8965
  • Fax: 301-251-0136
Mailing address:
  • Phone: 301-251-8965
  • Fax: 301-251-0136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number05937
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: