Healthcare Provider Details

I. General information

NPI: 1477666113
Provider Name (Legal Business Name): LISA MICHELLE HOFFMAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 09/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69-40 108TH STREET
FOREST HILLS NY
11375
US

IV. Provider business mailing address

PO BOX 655
FLORAL PARK NY
11002-0655
US

V. Phone/Fax

Practice location:
  • Phone: 917-865-5285
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number014593
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: