Healthcare Provider Details

I. General information

NPI: 1659955367
Provider Name (Legal Business Name): RANDOLPH ELLIS HOFFPAUIR LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2021
Last Update Date: 05/09/2021
Certification Date: 05/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 SAVANNAH RD APT 8
LEWES DE
19958-1483
US

IV. Provider business mailing address

PO BOX 130
LEWES DE
19958-0130
US

V. Phone/Fax

Practice location:
  • Phone: 302-448-9006
  • Fax:
Mailing address:
  • Phone: 302-448-9006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberQ1-0001761
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: