MEDICARE: MR. KENTON J KAUFFMAN LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	MH2837	FL

General Provider Information

NPI Number	:	1598750044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KENTON J KAUFFMAN LCSW

Provider Business Mailing Address
First Line	:	PO BOX 15258
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34277-1258
Country	:	US
Telephone Number	:	941-780-4192
Fax Number	:	941-925-8574

Provider Business Practice Location Address
First Line	:	3205 SOUTHGATE CIR
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34239-5514
Country	:	US
Telephone Number	:	941-780-4192
Fax Number	:	941-925-8574

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	04/29/2010

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