Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 68195 | CA |
NPI | 1003169129 |
---|---|
Provider Name | Mr. James Kaufman |
First Address | Oakland, CA 94611-5471 |
Second Address | Oakland, CA 94611-5471 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2012 |
Last Update Date | 26/10/2012 |