Healthcare Provider Details

I. General information

NPI: 1487775995
Provider Name (Legal Business Name): JENNIFER FAITH HOFFMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 01/10/2020
Certification Date: 01/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

361 PARK RD STE 203
WEST HARTFORD CT
06119-1911
US

IV. Provider business mailing address

361 PARK RD STE 203
WEST HARTFORD CT
06119-1911
US

V. Phone/Fax

Practice location:
  • Phone: 860-680-5289
  • Fax:
Mailing address:
  • Phone: 860-680-5289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number005921
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: