Healthcare Provider Details

I. General information

NPI: 1023334216
Provider Name (Legal Business Name): CLIFFORD ELLIOT HOBERMAN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2010
Last Update Date: 04/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1991 HYDE PARK ST
SARASOTA FL
34239-3612
US

IV. Provider business mailing address

1330 DARYL DR
SARASOTA FL
34232-2174
US

V. Phone/Fax

Practice location:
  • Phone: 941-953-4313
  • Fax: 941-954-8631
Mailing address:
  • Phone: 941-400-6277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW11237
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: