Healthcare Provider Details

I. General information

NPI: 1902440704
Provider Name (Legal Business Name): ALICIA HOFFMAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2019
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 N MAIN ST
WEST HARTFORD CT
06117-2515
US

IV. Provider business mailing address

9 DONNA DR
BURLINGTON CT
06013-1917
US

V. Phone/Fax

Practice location:
  • Phone: 203-816-0091
  • Fax:
Mailing address:
  • Phone: 207-317-0006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number4344
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: