Provider Demographics
NPI:1124745674
Name:KAUFHOLD, NOA HALVERSON (MSW)
Entity type:Individual
Prefix:
First Name:NOA
Middle Name:HALVERSON
Last Name:KAUFHOLD
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7212 STATE ROUTE 28
Mailing Address - Street 2:
Mailing Address - City:SHANDAKEN
Mailing Address - State:NY
Mailing Address - Zip Code:12480-5004
Mailing Address - Country:US
Mailing Address - Phone:619-379-7811
Mailing Address - Fax:
Practice Address - Street 1:4166 STATE ROUTE 28
Practice Address - Street 2:
Practice Address - City:BOICEVILLE
Practice Address - State:NY
Practice Address - Zip Code:12412-5203
Practice Address - Country:US
Practice Address - Phone:845-657-2373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-25
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW137632104100000X
NY118367104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker