Provider Demographics
NPI:1942362744
Name:KAUFMAN, SUE ANN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SUE
Middle Name:ANN
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5430 N PALM AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704
Mailing Address - Country:US
Mailing Address - Phone:559-438-1200
Mailing Address - Fax:559-438-1413
Practice Address - Street 1:5430 N PALM AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704
Practice Address - Country:US
Practice Address - Phone:559-438-1200
Practice Address - Fax:559-438-1413
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS90881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11331800OtherCAQH
ZZZ17559ZMedicare ID - Type Unspecified