Healthcare Provider Details

I. General information

NPI: 1013287168
Provider Name (Legal Business Name): THOMAS KAUFFMANN LICSW, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2012
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

182 BARKER RD
LONDONDERRY VT
05148-6508
US

IV. Provider business mailing address

PO BOX 370
LONDONDERRY VT
05148-0370
US

V. Phone/Fax

Practice location:
  • Phone: 802-365-1643
  • Fax:
Mailing address:
  • Phone: 801-520-9787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9539574-3501
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089.0134372
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: