Healthcare Provider Details

I. General information

NPI: 1225676802
Provider Name (Legal Business Name): ELANA HOFFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2019
Last Update Date: 12/14/2019
Certification Date: 12/14/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5247 WISCONSIN AVE NW STE 4
WASHINGTON DC
20015-2012
US

IV. Provider business mailing address

5247 WISCONSIN AVE NW STE 4
WASHINGTON DC
20015-2012
US

V. Phone/Fax

Practice location:
  • Phone: 201-686-7699
  • Fax:
Mailing address:
  • Phone: 202-686-7699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number06115
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY1001529
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: