Healthcare Provider Details

I. General information

NPI: 1902396864
Provider Name (Legal Business Name): PRISCILLA HOFFNUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2018
Last Update Date: 05/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 ASHCROFT ST
JAMAICA PLAIN MA
02130-4325
US

IV. Provider business mailing address

29 ASHCROFT ST
JAMAICA PLAIN MA
02130-4325
US

V. Phone/Fax

Practice location:
  • Phone: 617-522-7070
  • Fax: 617-971-9746
Mailing address:
  • Phone: 617-721-5257
  • Fax: 617-971-9746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number2363
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: