Healthcare Provider Details

I. General information

NPI: 1053010371
Provider Name (Legal Business Name): SHANI HOFFMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2023
Last Update Date: 07/08/2023
Certification Date: 07/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 PONTE VEDRA LAKES BLVD APT 2306
PONTE VEDRA BEACH FL
32082-1246
US

IV. Provider business mailing address

611 PONTE VEDRA LAKES BLVD APT 2306
PONTE VEDRA BEACH FL
32082-1246
US

V. Phone/Fax

Practice location:
  • Phone: 904-800-8835
  • Fax:
Mailing address:
  • Phone: 904-800-8835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12977
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: