Provider Demographics
NPI:1174710974
Name:KAUFMAN, DEBORAH ANNE (MA, COD, IMF, BFA)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANNE
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:MA, COD, IMF, BFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 16TH ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-1235
Mailing Address - Country:US
Mailing Address - Phone:310-828-1113
Mailing Address - Fax:310-828-9543
Practice Address - Street 1:1245 16TH ST
Practice Address - Street 2:SUITE 210
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1235
Practice Address - Country:US
Practice Address - Phone:310-734-9384
Practice Address - Fax:310-828-9543
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAIMF 59270OtherBOARD OF BEHAVIORAL SCIENCE