Healthcare Provider Details

I. General information

NPI: 1255496527
Provider Name (Legal Business Name): RICHARD DAVID KOFSKY PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9701 SANDRA LN
MINNETONKA MN
55305-4632
US

IV. Provider business mailing address

9701 SANDRA LN
MINNETONKA MN
55305-4632
US

V. Phone/Fax

Practice location:
  • Phone: 952-935-7864
  • Fax: 952-935-7864
Mailing address:
  • Phone: 952-935-7864
  • Fax: 952-935-7864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberLP2471
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: