Healthcare Provider Details

I. General information

NPI: 1518771096
Provider Name (Legal Business Name): MARITSA HOFHERR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2025
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6557 KOZIARA DR
BURKE VA
22015-4131
US

IV. Provider business mailing address

6557 KOZIARA DR
BURKE VA
22015-4131
US

V. Phone/Fax

Practice location:
  • Phone: 917-420-0800
  • Fax:
Mailing address:
  • Phone: 917-420-0800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number0001296741
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: