Healthcare Provider Details

I. General information

NPI: 1467661579
Provider Name (Legal Business Name): JEREMY D KAUFMAN PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 01/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 S 3RD ST STE. 210
COLUMBUS OH
43215-4206
US

IV. Provider business mailing address

20 S 3RD ST STE. 210
COLUMBUS OH
43215-4206
US

V. Phone/Fax

Practice location:
  • Phone: 614-636-4779
  • Fax:
Mailing address:
  • Phone: 614-636-4779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6339
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6339
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number6339
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number6339
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number6339
License Number StateOH
# 6
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number6339
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: