Healthcare Provider Details

I. General information

NPI: 1558331686
Provider Name (Legal Business Name): J SCHUYLER HOFFMAN PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 09/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 PLEASANT ST
GLOUCESTER MA
01930-5937
US

IV. Provider business mailing address

PO BOX 3150
GLOUCESTER MA
01931-3150
US

V. Phone/Fax

Practice location:
  • Phone: 978-282-4669
  • Fax: 978-282-1620
Mailing address:
  • Phone: 978-282-4669
  • Fax: 978-282-1620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number4994
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: