Healthcare Provider Details

I. General information

NPI: 1215673819
Provider Name (Legal Business Name): JUSTIN JOHN HOFFMAN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2022
Last Update Date: 05/07/2022
Certification Date: 05/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1651 N WASHINGTON ST APT 25
DENVER CO
80203-1435
US

IV. Provider business mailing address

1651 N WASHINGTON ST APT 25
DENVER CO
80203-1435
US

V. Phone/Fax

Practice location:
  • Phone: 954-309-2559
  • Fax:
Mailing address:
  • Phone: 954-309-2559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number09927900
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: