Healthcare Provider Details

I. General information

NPI: 1154547149
Provider Name (Legal Business Name): LISA JANE HOFFMEYER PH.D. LICENSED PSCYH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2324 W JOPPA RD SUITE 420
LUTHERVILLE MD
21093-4615
US

IV. Provider business mailing address

9 MADISON MILLS CT
CATONSVILLE MD
21228-2538
US

V. Phone/Fax

Practice location:
  • Phone: 410-983-2698
  • Fax:
Mailing address:
  • Phone: 410-788-2686
  • Fax: 410-321-9531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2821
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: