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General NPI Number Information
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NPI Number | 1710421037
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Entity Type | Individual
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Provider Name | MARY KAUFMAN LICSW ASSOCIATE
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Gender | Female
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Dates
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Enumeration Date | 12/05/2016
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Last Update Date | 09/22/2025
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Provider Practice Location Address
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Address Line | 108 SE 124TH AVE STE 6
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City | VANCOUVER
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State | WA
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Zip | 98684-6015
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Country | US
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Telephone | 360-910-1662
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Fax | 360-989-1162
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Provider Business Mailing Address
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Address Line | 3600 A ST APT 29
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City | WASHOUGAL
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State | WA
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Zip | 98671-2657
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Country | US
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Telephone | 360-910-1662
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Fax | 360-989-1162
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LW60781542
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License Number State | WA
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