Healthcare Provider Details

I. General information

NPI: 1720117641
Provider Name (Legal Business Name): BARRY JAMES HOFFMAN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 09/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4212 OLD GRAND AVE SUITE 102
GURNEE IL
60031-2708
US

IV. Provider business mailing address

4212 OLD GRAND AVE SUITE 102
GURNEE IL
60031-2708
US

V. Phone/Fax

Practice location:
  • Phone: 847-336-5621
  • Fax: 847-336-2594
Mailing address:
  • Phone: 847-336-5621
  • Fax: 847-336-2594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: