Provider Demographics
NPI:1487812483
Name:KOUFFMAN, HEATHER CANDACE (LMSW PHYCHOTHERAPIST)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:CANDACE
Last Name:KOUFFMAN
Suffix:
Gender:F
Credentials:LMSW PHYCHOTHERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 EAST 29TH STREET APT 8F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016
Mailing Address - Country:US
Mailing Address - Phone:917-544-3899
Mailing Address - Fax:
Practice Address - Street 1:260 MADISON AVENUE
Practice Address - Street 2:SUITE 800
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:917-544-3899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYLMSW076775104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker