Healthcare Provider Details

I. General information

NPI: 1619765005
Provider Name (Legal Business Name): MATTHEW THOMAS HOFFMANN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 04/28/2025
Certification Date: 04/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 TENNIS AVE
GLENSIDE PA
19038-1805
US

IV. Provider business mailing address

818 TENNIS AVE
GLENSIDE PA
19038-1805
US

V. Phone/Fax

Practice location:
  • Phone: 215-260-1419
  • Fax: 215-260-1419
Mailing address:
  • Phone: 215-260-1419
  • Fax: 215-260-1419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC018388
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: