Healthcare Provider Details

I. General information

NPI: 1679138796
Provider Name (Legal Business Name): HALLIE DYLAN HOFFMAN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2019
Last Update Date: 11/08/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 DOBBIN ST
BROOKLYN NY
11222-5502
US

IV. Provider business mailing address

375 89TH ST
DALY CITY CA
94015-1802
US

V. Phone/Fax

Practice location:
  • Phone: 917-243-9770
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number114457
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: