Healthcare Provider Details

I. General information

NPI: 1669956447
Provider Name (Legal Business Name): GABRIEL GERARD HOFF MHC, LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2018
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 MAIN ST STE A
CORTLAND NY
13045-3191
US

IV. Provider business mailing address

165 MAIN ST STE A
CORTLAND NY
13045-3191
US

V. Phone/Fax

Practice location:
  • Phone: 607-753-0234
  • Fax:
Mailing address:
  • Phone: 607-753-0234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number026439
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: