Healthcare Provider Details

I. General information

NPI: 1245659846
Provider Name (Legal Business Name): ROBERTA HOFFMAN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2014
Last Update Date: 04/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE
BOSTON MA
02115-5724
US

IV. Provider business mailing address

300 LONGWOOD AVENUE
BOSTON MA
02467
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-8047
  • Fax:
Mailing address:
  • Phone: 617-355-8047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1020638
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: