Provider Demographics
NPI:1063609618
Name:KAUFMAN, BILL (MFT)
Entity type:Individual
Prefix:MR
First Name:BILL
Middle Name:
Last Name:KAUFMAN
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-3535
Mailing Address - Country:US
Mailing Address - Phone:310-392-3740
Mailing Address - Fax:310-392-6043
Practice Address - Street 1:2510 MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-3535
Practice Address - Country:US
Practice Address - Phone:310-392-3740
Practice Address - Fax:310-392-6043
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8487106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist