Basic Information
| Provider Information | |||||||||
| NPI: | 1265473961 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAUFFMAN | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | E. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | RR 1 BOX 168 | ||||||||
| Address2: | |||||||||
| City: | DORNSIFE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178239610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5704252371 | ||||||||
| FaxNumber: | 5705249492 | ||||||||
| Practice Location | |||||||||
| Address1: | 32 WHISPER CREEK DR | ||||||||
| Address2: | SUITE 7 | ||||||||
| City: | LEWISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178377770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5705220304 | ||||||||
| FaxNumber: | 5705220304 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2006 | ||||||||
| LastUpdateDate: | 05/21/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | SW-123557 | PA | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | CW015380 | PA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 50044331 | 01 | PA | CAPITAL BLUE CROSS | OTHER |