Healthcare Provider Details

I. General information

NPI: 1942079090
Provider Name (Legal Business Name): KATELYN MARGARET HOFFMAN BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2023
Last Update Date: 12/29/2023
Certification Date: 12/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 REDLAND CT STE 102
OWINGS MILLS MD
21117-3265
US

IV. Provider business mailing address

100 SHAWAN RD UNIT 363
COCKEYSVILLE MD
21030-1477
US

V. Phone/Fax

Practice location:
  • Phone: 844-854-2583
  • Fax:
Mailing address:
  • Phone: 717-870-9667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA1707
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: