Healthcare Provider Details

I. General information

NPI: 1962805721
Provider Name (Legal Business Name): NICOLE KAUFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2014
Last Update Date: 06/03/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 COTTONWOOD CT NW
ALBUQUERQUE NM
87107-6633
US

IV. Provider business mailing address

221 COTTONWOOD CT NW
ALBUQUERQUE NM
87107-6633
US

V. Phone/Fax

Practice location:
  • Phone: 480-518-0937
  • Fax:
Mailing address:
  • Phone: 480-518-0937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberX-08612
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-10343
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: