Healthcare Provider Details

I. General information

NPI: 1811878143
Provider Name (Legal Business Name): JENNIFER HOFFER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2025
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 FOREST AVE STE 7E
PORTLAND ME
04101-1520
US

IV. Provider business mailing address

124 PARK AVE APT 15
PORTLAND ME
04101-2124
US

V. Phone/Fax

Practice location:
  • Phone: 973-494-6095
  • Fax:
Mailing address:
  • Phone: 973-494-6095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberXL8303
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: