Provider Demographics
NPI:1710421037
Name:KAUFMAN, MARY (LICSW ASSOCIATE)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:LICSW ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 A ST APT 29
Mailing Address - Street 2:
Mailing Address - City:WASHOUGAL
Mailing Address - State:WA
Mailing Address - Zip Code:98671-2657
Mailing Address - Country:US
Mailing Address - Phone:360-910-1662
Mailing Address - Fax:360-989-1162
Practice Address - Street 1:108 SE 124TH AVE STE 6
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-6015
Practice Address - Country:US
Practice Address - Phone:360-910-1662
Practice Address - Fax:360-989-1162
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-05
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW607815421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical