Healthcare Provider Details

I. General information

NPI: 1366729121
Provider Name (Legal Business Name): KYLE KAUFER LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2011
Last Update Date: 05/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 HAMLET AVE
WOONSOCKET RI
02895-4423
US

IV. Provider business mailing address

58 HAMLET AVE
WOONSOCKET RI
02895-4423
US

V. Phone/Fax

Practice location:
  • Phone: 401-724-8400
  • Fax: 401-722-5280
Mailing address:
  • Phone: 401-724-8400
  • Fax: 401-722-5280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: