Healthcare Provider Details

I. General information

NPI: 1578371175
Provider Name (Legal Business Name): KEYAUNA L HOFFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2024
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HANCOCK ST APT 30
BOSTON MA
02125-2168
US

IV. Provider business mailing address

200 HANCOCK ST APT 30
BOSTON MA
02125-2168
US

V. Phone/Fax

Practice location:
  • Phone: 617-291-7520
  • Fax:
Mailing address:
  • Phone: 617-291-7520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: