Healthcare Provider Details

I. General information

NPI: 1891995734
Provider Name (Legal Business Name): ROBERT PAGE KAUFMAN LCSW/MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 04/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 CAMINO PINON
SANTA FE NM
87508-1903
US

IV. Provider business mailing address

17 CAMINO PINON
SANTA FE NM
87508-1903
US

V. Phone/Fax

Practice location:
  • Phone: 505-930-1477
  • Fax:
Mailing address:
  • Phone: 505-930-1477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-06713
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number06020
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-06713
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: