Provider Information for 1295014819
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GREGORY MARK KAUFMAN LICSW
Sex: Male
NPI: 1295014819
Last Updated: 2011-08-15
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1295014819 | ||||||||
| Enumeration Date | 2011-08-13 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 78 COLLEGE AVE SOMERVILLE, MA 02144-1916 United States Phone: 617-623-3278 | Fax: | ||||||||
| Primary Practice Address | 78 COLLEGE AVE SOMERVILLE, MA 02144-1916 United States Phone: 617-623-3278 | Fax: | ||||||||
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