Healthcare Provider Details

I. General information

NPI: 1992910194
Provider Name (Legal Business Name): SUE ANN HOFFMAN M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 NORTHWESTERN DR
COAL TOWNSHIP PA
17866-4167
US

IV. Provider business mailing address

1 HILLCREST DR
ELYSBURG PA
17824-9690
US

V. Phone/Fax

Practice location:
  • Phone: 570-644-5350
  • Fax: 570-644-5396
Mailing address:
  • Phone: 570-672-2260
  • Fax: 570-644-5396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS006898-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: