=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073964961
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SERAPHINA INTEGRATIVE WELLNESS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2016
-----------------------------------------------------
Last Update Date | 06/24/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1449 OLD WATERBURY RD SUITE 307 A
-----------------------------------------------------
City | SOUTHBURY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06488-3926
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-709-0325
-----------------------------------------------------
Fax | 203-405-6972
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 772 710 MAIN STREET SOUTH
-----------------------------------------------------
City | SOUTHBURY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06488-0772
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-709-0325
-----------------------------------------------------
Fax | 203-405-6972
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MICHAELA KAUFFMANN
-----------------------------------------------------
Credential | N.D., PSY.D., L.AC.
-----------------------------------------------------
Telephone | 203-709-0325
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 000504
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 175F00000X
-----------------------------------------------------
Taxonomy Name | Naturopath
-----------------------------------------------------
License Number | 000415
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 001965
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------