Healthcare Provider Details

I. General information

NPI: 1083998611
Provider Name (Legal Business Name): KAUFMAN PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2011
Last Update Date: 09/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 WASHINGTON AVE STE 102
PORTLAND ME
04103-3636
US

IV. Provider business mailing address

1321 WASHINGTON AVE STE 102
PORTLAND ME
04103-3636
US

V. Phone/Fax

Practice location:
  • Phone: 207-878-1777
  • Fax: 207-839-7733
Mailing address:
  • Phone: 207-878-1777
  • Fax: 207-839-7733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTOPHER JAMES KAUFMAN
Title or Position: CLINICAL DIRECTOR
Credential: PH.D.
Phone: 207-878-1717