Healthcare Provider Details

I. General information

NPI: 1861170912
Provider Name (Legal Business Name): JUDITH GOURSE HOFFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2023
Last Update Date: 07/10/2023
Certification Date: 07/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 NARRAGANSETT PKWY
WARWICK RI
02888-4537
US

IV. Provider business mailing address

320 NARRAGANSETT PKWY
WARWICK RI
02888-4537
US

V. Phone/Fax

Practice location:
  • Phone: 401-580-8765
  • Fax:
Mailing address:
  • Phone: 401-580-8765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW00994
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: