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General NPI Number Information
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NPI Number | 1306817994
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Entity Type | Individual
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Provider Name | MARCIA BONNIE KAUFMAN PH.D.
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Gender | Female
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Dates
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Enumeration Date | 01/31/2006
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Last Update Date | 07/08/2011
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Provider Practice Location Address
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Address Line | 115 PARK ST SE SUITE 207
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City | VIENNA
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State | VA
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Zip | 22180-4653
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Country | US
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Telephone | 703-938-9090
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Fax | 703-938-9091
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Provider Business Mailing Address
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Address Line | 115 PARK ST SE SUITE 207
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City | VIENNA
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State | VA
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Zip | 22180-4653
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Country | US
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Telephone | 703-938-9090
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Fax | 703-938-9091
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS006137L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | VA0810004426
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY1000608
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License Number State | DC
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