Healthcare Provider Details

I. General information

NPI: 1710371364
Provider Name (Legal Business Name): DEBRA A. ANN HOFFMANN L.M.S.W
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2015
Last Update Date: 03/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6708 64TH ST APT 2 LT
RIDGEWOOD NY
11385-4632
US

IV. Provider business mailing address

6708 64TH ST APT 2 LT
RIDGEWOOD NY
11385-4632
US

V. Phone/Fax

Practice location:
  • Phone: 718-501-0799
  • Fax:
Mailing address:
  • Phone: 718-501-0799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number# 091626-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: