Healthcare Provider Details

I. General information

NPI: 1649368549
Provider Name (Legal Business Name): GREGORY HOFSTETTER PH.ED
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 12/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 VIRGINIA AVE
ROCHESTER PA
15074-1723
US

IV. Provider business mailing address

9474 VIEWCREST DR
ALLISON PARK PA
15101-1942
US

V. Phone/Fax

Practice location:
  • Phone: 724-775-5208
  • Fax:
Mailing address:
  • Phone: 412-366-4933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS003913L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: