Provider Demographics
NPI:1447692074
Name:KAUFMAN, MARK (LSCSW)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:KAUFMAN
Suffix:
Gender:M
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4115 SW EMLAND DR APT 3
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-2123
Mailing Address - Country:US
Mailing Address - Phone:785-272-5501
Mailing Address - Fax:
Practice Address - Street 1:4123 SW GAGE CENTER DR STE 130
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-1886
Practice Address - Country:US
Practice Address - Phone:785-272-5501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical