Healthcare Provider Details

I. General information

NPI: 1285115410
Provider Name (Legal Business Name): MEGAN CORK HOFFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2018
Last Update Date: 08/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 AMORY ST STE 3
JAMAICA PLAIN MA
02130-2672
US

IV. Provider business mailing address

75 STRATHMORE RD APT A
BRIGHTON MA
02135-7738
US

V. Phone/Fax

Practice location:
  • Phone: 508-479-1573
  • Fax:
Mailing address:
  • Phone: 973-309-1248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: