Healthcare Provider Details

I. General information

NPI: 1437314747
Provider Name (Legal Business Name): MONIQUE HOFFMAN LMSW CC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2008
Last Update Date: 07/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 GANNETT DRIVE STE 300
SOUTH PORTLAND ME
04106
US

IV. Provider business mailing address

324 GANNETT DRIVE SUITE 300
SOUTH PORTLAND ME
04106
US

V. Phone/Fax

Practice location:
  • Phone: 207-771-5711
  • Fax: 207-771-5755
Mailing address:
  • Phone: 207-771-5700
  • Fax: 207-771-5755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberMC 11259
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: