Healthcare Provider Details

I. General information

NPI: 1114227154
Provider Name (Legal Business Name): DANA HOFFMAN BLUSTAJN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DANA HOFFMAN LCSW

II. Dates (important events)

Enumeration Date: 10/25/2010
Last Update Date: 10/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 WHITNEY AVE
NEW HAVEN CT
06511-3715
US

IV. Provider business mailing address

103 CANNER ST
NEW HAVEN CT
06511-2201
US

V. Phone/Fax

Practice location:
  • Phone: 415-595-6841
  • Fax:
Mailing address:
  • Phone: 415-595-6841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number007284
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: