Healthcare Provider Details

I. General information

NPI: 1487876413
Provider Name (Legal Business Name): LAURIE HOFMANN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 02/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 BRUNSWICK AVE
GARDINER ME
04345-2123
US

IV. Provider business mailing address

17 BRUNSWICK AVE
GARDINER ME
04345-2123
US

V. Phone/Fax

Practice location:
  • Phone: 207-582-8138
  • Fax: 207-582-8138
Mailing address:
  • Phone: 207-582-8138
  • Fax: 207-582-8138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMF3691
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: